Breaking Narrative Ground: Innovative Methods for Rigorously Eliciting and Assessing Patient Narratives

Objective. To design a methodology for rigorously eliciting narratives about patients' experiences with clinical care that is potentially useful for public reporting and quality improvement. Data Sources/Study Setting. Two rounds of experimental data (N = 48 each) collected in 2013-2014, using a nationally representative Internet panel. Study Design. Our study (1) articulates and operationalizes criteria for assessing narrative elicitation protocols; (2) establishes a "gold standard" for assessment of such protocols; and (3) creates and tests a protocol for narratives about outpatient treatment experiences. Data Collection/Extraction Methods. We randomized participants between telephone and web-based modalities and between protocols placed before and after a closed-ended survey. Principal Findings. Elicited narratives can be assessed relative to a gold standard using four criteria: (1) meaningfulness, (2) completeness, (3) whether the narrative accurately reflects the balance of positive and negative events, and (4) representativeness, which reflects the protocol's performance across respondent subgroups. We demonstrate that a five-question protocol that has been tested and refined yields three-to sixfold increases in completeness and four-to tenfold increases in meaningfulness, compared to a single open-ended question. It performs equally well for healthy and sick patients. Conclusions. Narrative elicitation protocols suitable for inclusion in extant patient experience surveys can be designed and tested against objective performance criteria, thus advancing the science of public reporting.