My Life, My Story: An Approach to What Matters Most

Background

One of the most vulnerable things a person can share is their life story. Life stories connect physicians to patients’ hopes and values and invite the interprofessional team to learn more about how patients have experienced life events that have shaped who they are. My Life, My Story (MLMS) is a narrative medicine program developed at the Madison VA Medical Center in 2013.¹ The program allows the healthcare team to learn what Matters Most to patients and in turn, further support goal-concordant care. MLMS gives Veterans the opportunity to share their stories and have them recorded in a durable document in the Electronic Health Record (EHR). MLMS is present in 75 VA facilities with more than 8,000 stories completed. The program has gained momentum and garnered interest at non-VA facilities who have implemented MLMS.

First, a Veteran is interviewed by a trained volunteer or learner, then the draft of the transcript is shared with the Veteran prior to being transcribed into an MLMS note in the EHR. Stories are written in first person and in the Veteran’s own words. Stories are recorded under the note title, “My Story” and can be easily accessed by all team members when viewing the Veteran’s postings in the VA’s EHR which is called CPRS. All experiences (big and small) shared with the healthcare team are honored.

This bidirectional relationship of interviewing, listening, sharing, and editing deepens connections between Veterans and care teams. These connections enhance patient care and health outcomes.³ Care teams have greater insight into experiences that have impacted a Veteran, and this knowledge informs care teams about what Matters Most to the Veteran (aligning with what Matters in the IHI Age-Friendly 4Ms framework).⁴ All stories are meaningful as they offer a glimpse into the lives of patients and provide information the healthcare team may not know or learn.

Our Journey at the Cincinnati VA

In January 2020, an interprofessional team at the Cincinnati VAMC, collaborated to bring MLMS to our facility. Fifteen employees and volunteers participated in a one-day training on MLMS through the national Veterans Experience Office. We worked with our local health informatics specialist to create an MLMS consult and note template. Medical media printed brochures to promote the program. Our local Patient and Family Advisory Council and Veterans of Foreign Wars Department of Ohio Charities generously donated money to purchase audio recorders. MLMS was officially launched at the Cincinnati VA in January 2021.

Interviewers include volunteers through the Voluntary Services as well as trainees (medical students, residents, and fellows) during their geriatric medicine rotation. Volunteers recruited through Voluntary Services are offered a virtual two-day training created by the Madison VA Medical Center. Trainees on the geriatric medicine rotation receive truncated training, focusing on training guides developed at the Boston VA Medical Center. Interviewers connect with Veterans residing in the VA’s Community Living Center (CLC, a skilled nursing facility connected to the main hospital), admitted to the hospital, or residing in the community via telephone. Interviewers obtain consent from the Veteran and conduct a 60–90-minute interview via a combination of scripted and open-ended questions. Stories are documented and condensed for length by the interviewer, shared with the veteran for additional editing, printed for the Veteran, and then completed as an MLMS note in the EHR.

In 2020, the Cincinnati VAMC received funding through the Innovation Network to bring Reno VA Medical Center’s Through Our Eyes—The Women Veterans’ Experience project to our VA—an MLMS display featuring women Veteran stories. The first display was featured at the “Operation Thank You” event in September 2022. The Cincinnati VAMC MLMS project has connected with a broader narrative medicine effort in our region as we partner with other individuals and institutions who are passionate about Narrative Medicine, Compassionate Arts and Healing.

Outcomes

The goal of MLMS is to provide a meaningful opportunity for Veterans to share their life stories with their care teams and help them better understand the Veterans they serve. Five years after MLMS was implemented at the Madison VA Medical Center, healthcare staff were recruited to complete a survey with closed and open-ended items. Descriptive statistics and thematic analysis were used to analyze the results and they found that 94% of staff indicated they had read MLMS notes and more than 86% agreed or strongly agreed that reading the notes was a good use of their time and improved their care of the Veteran.¹

The Boston VA Medical Center’s MLMS program is integrated into trainees’ education, enhancing patient-centered care. In 2019, 482 stories were compiled by trainees from 7 disciplines. The trainees spent about 2 hours assembling the stories and 84% felt that doing so was a good use of their time.²

Conclusion

The Cincinnati VAMC plans to measure the impact of MLMS on Veterans, their care partners, and care teams by partnering with local academic institutions. We hope to increase our volunteer base, expand educational integration to trainees in other departments and create innovative ways to share and honor our Veterans’ stories.

Your patients’ stories are meaningful; knowing them can improve the care you deliver. Patient experiences often inform their healthcare choices and goals. By understanding your patients’ life histories, you can deliver better goal-concordant care. We encourage you to hear your patients’ stories as we hope it helps you to find increased fulfillment and purpose in your practice.

SGIM members who are interested in building or expanding MLMS at their facility may reach out to the authors of this article.