Digital Narrative Medicine: Translating Stories Into Medical Education and Better Patient Care

Candice Marie Sage, PhD, is a storyteller and researcher with over 20 years of experience managing interdisciplinary research in Canada and internationally. She is an expert in knowledge co-creation, translation, and exchange. In this piece, she provides an overview of some of the applications of digital narrative medicine, kicking off a series in which she will explore digital narrative medicine stories and applications in depth.

About four decades ago, narrative medicine (NM) emerged as an important diagnostic tool [1], one that treats illness as a human experience and not just a biological one. NM is an approach to clinical care that recognizes the importance of lived experiences in health care, training clinicians in skills like reflective writing and authentic communication with patients [2]. By listening to, analyzing, and integrating patients’ stories along with standard test results and traditional tools, clinicians can gain a deeper understanding of their patients, improving health outcomes [3,4].

Today, with an arsenal of novel tools and technologies, digital narrative medicine (DNM) provides new ways to capture and incorporate patient stories to enhance meaning-making [5]. It augments traditional NM by using digital tools to improve the accessibility, scalability, and inclusivity of narrative practices [2].

With applications from medical education to clinical interventions and across diverse populations, DNM enhances how health care professionals understand, relate to, and communicate with patients, their families, and caregivers, while providing a platform for empowerment through patient advocacy and treatment co-design [6].

DNM as Knowledge Translation

As care moves away from direct interactions between patients and health care professionals toward remote and asynchronous care, DNM functions as a bridge [2]. It helps build a humanizing connection between patients and their care teams, grounding care in lived experience and making knowledge translation a reciprocal process.

An increasing number of tools support this shift in how knowledge flows, allowing patient stories to be captured and used in more flexible, creative ways. Examples include multimedia podcasts and curated videos, leveraging artificial intelligence to translate stories into training simulation scenarios and clinical decision support [7], and interactive games that allow patients, their families, and their care teams to engage and interact dynamically. These DNM tools foster greater empathy between patients, their families, and clinicians, leading to more comprehensive, patient-centered care [8].

Applications in Medical Education

Before the digital age, medical education was based on attending different hospital rotations and observing, with depth of learning dependent on the chance clinical presentations and procedures taking place at that given time.

Today, DNM’s narrative-based training and interactive storytelling systems provide virtually endless scenarios for trainees to experience and practice their diagnostic and decision-making skills. Trainees’ reflective writing exercises are captured electronically in “e-portfolios” and then evaluated by trainers to nurture narrative competence, defined as “the ability to absorb, interpret, and act upon patient stories” [2]. Exposure to the authentic voices of patients—and, increasingly, family and caregivers—helps provide not only information about medical care, but also context around culture and other social determinants of health—enhancing trainees’ empathy, communication skills, and professional identity [9].

One such example is the Out of Darkness multimedia project in Toronto, Canada [10]. People living with bipolar disorder were video-graphed, capturing their recovery journeys and lived experiences at home and in their neighborhoods. Psychiatry trainees were exposed to very realistic aspects of bipolar illness, like what it feels like to take lithium, undergo electroconvulsive therapy, or experience fear of relapse and suicidality. By watching these emotionally evocative short films, learners gained treatment-relevant insights and reported increased empathy and compassion.

Applications in Clinical Intervention

Beyond training, DNM enhances patient-centered care by providing health professionals with highly contextual accounts of patients’ psychological, emotional, social, and spiritual lived experiences [11]. This information can be collected and stored in medical records, analyzed with artificial intelligence tools, and made more accessible to both patients and practitioners in real time or longitudinally. Holistic, wraparound care is enhanced when professional teams collaborate by sharing insights and meaning-making about patient stories [12].

Cancer care digital storytelling, for example, has existed for more than a decade through initiatives like the Canadian Cancer Society’s 2018 partnership with digital storyteller Mike Lang, which provided a platform for cancer patients to tell their stories and reflect on their journeys [13]. Earlier, in 2015, I coordinated a Cancer Care Ontario project, collecting and analyzing the lived experiences of patients and practitioners. More deeply understanding each group’s needs and experiences led us to shift 5-year follow-up care for colorectal and breast cancer survivors from oncology specialists to local primary care providers. Follow-up surveys showed this new care plan improved each group’s experiences, freeing specialists up to focus on active oncology care and reducing patients’ travel time [14].

DNM is also used in palliative and end-of-life care and research [15] and can help facilitate difficult discussions about advanced care and end-of-life planning [16]. For example, I led an award-winning palliative care redesign project at Kingston General Hospital in 2018; the key to our success was incorporating members of the hospital’s Patient and Family Engagement Committee early on and throughout the redesign. We learned about more than palliative care—we also learned what it was like to navigate the health care system as a patient with multiple specialists, and about the burdens carried by both patients and their at-home caregivers. One patient was so ashamed of his illness that he forbade his wife from telling family or friends about the situation. She held that burden all by herself until after he died. Stories like this informed modifications to disclosure in a patient and family communications DNM intervention.

Game-based DNM interventions in clinical and mental health care are growing, bridging treatment, engagement, and implementation gaps. For teens and young adults with cancer, for example, a video game intervention greatly improved patients’ compliance with their treatment regimens through increased knowledge and self-efficacy [17].

Applications for Marginalized Populations

DNM can be particularly valuable for advancing health equity, and it can be an empowering tool for marginalized populations like youth [18], racialized groups [19], people with diverse sexual orientations and gender identities [20], Indigenous peoples [21], and people experiencing mental health [22] and substance use challenges [23].

The Mental Health Story Teller Mob developed by Australia’s Aboriginal and Islander Mental Health Initiative is an example of Indigenous-led digital narrative storytelling. It explores emotional and social well-being, coping, and resilience in the face of poverty, racism, stigma, and mental health and substance use challenges [24].

In my work on the Support Not Stigma project [25], we recorded short videos and a documentary for a regional antistigma campaign, capturing and sharing the stories of people living with mental health or substance use challenges—many of whom were also experiencing homelessness—and the workers supporting them. This not only provided a platform for amplifying their voices and educating the public, it also led to the discovery that over 90% of this population had experienced head traumas. This serious medical consideration would not have been known had we not delved into people’s stories.

Future Considerations

DNM is a powerful, underutilized approach that is gaining traction. As it continues to develop and expand, there are several important considerations.

New methodologies are needed to better plan and evaluate DNM research, curriculum development, and clinical practice. Ethical considerations—such as the consent of patient and family storytellers, and how their stories are used—will require dialog between patients, health care professionals, researchers, and policymakers. As technology evolves, new methods and tools to further comprehensive, person-centered care will emerge and require refinement.

We’re only just scratching the surface of the realm of possibilities DNM presents. With careful planning, thorough research, and thoughtful implementation, we can realize its potential for deepening and improving care for patients from all walks of life.