Keywords
Holistic Qualitative Case Study
Narrative Interview
Narrative Nursing
Nurse-led Intervention
How to Cite
Abstract
Objectives. A diagnosis of hematologic malignancy represents a major biographical disruption, affecting emotional, relational, and existential dimensions of patients’ lives. While biomedical care predominates, patients’ lived experiences during the early diagnostic phase remain insufficiently explored. This study protocol aims to investigate whether nurse-led narrative interviews conducted within the first month after diagnosis can strengthen the therapeutic relationship, enhance trust, support emotional expression, and sustain patients’ sense of identity and agency.
Trial Design. This study adopts a qualitative, holistic single-case study design, grounded in a constructivist–existentialist epistemological framework. An exploratory approach is used to generate in-depth, context-sensitive insights and inform future larger-scale qualitative research.
Participants and Settings. The study will be conducted in the onco-hematology department of a tertiary hospital in Northern Italy. One adult patient (≥18 years) with a first diagnosis of hematologic malignancy within the previous 30 days will be recruited through purposive sampling. A primary caregiver will also be involved to provide a complementary perspective. Inclusion criteria include linguistic competence in Italian and clinical stability to provide informed consent.
Interventions. The intervention consists of two nurse-led narrative interviews conducted approximately 15 days apart. Interviews will be guided by open-ended questions and conducted by a trained nurse using attentive, empathetic listening. Additional data sources include reflective writing by both the patient and the nurse following each interview, and a semi-structured interview with the caregiver after the second narrative interview.
Primary and Secondary Outcomes. Primary outcomes focus on qualitative indicators of meaning-making, emotional expression, therapeutic alliance, and perceived support as expressed through narratives and reflections. Secondary outcomes include triangulated insights from nurse, caregiver, and researcher perspectives. Data will be analyzed using Reflexive Thematic Analysis, with methodological triangulation to enhance rigor and credibility.
Conclusions. This protocol will describe a holistic qualitative single-case study exploring the impact of nurse-led narrative interventions on relational and meaning-making processes in patients newly diagnosed with hematologic malignancies, providing a foundation for future person-centered research and clinical integration.
References
Abdallah, M., Kadambi, S., Parsi, M., Rai, M., Mendler, J. H., & Wittink, M. (2022). Older patients’ experiences following initial diagnosis of acute myeloid leukemia: A qualitative study. Journal of Geriatric Oncology, 13(8), 1230–1235. https://doi.org/10.1016/j.jgo.2022.08.017
Adeoye-Olatunde, O. A., & Olenik, N. L. (2021). Research and scholarly methods: Semi-structured interviews. Journal of the American College of Clinical Pharmacy, 4(10), 1358–1367. https://doi.org/10.1002/jac5.1441
Anderson, C., Harrigan, M., George, S. M., Ferrucci, L. M., Sanft, T., & Irwin, M. L. (2016). Changes in diet quality in a randomized weight loss trial in breast cancer survivors: The lifestyle, exercise, and nutrition (LEAN) study. NPJ Breast Cancer, 2(1), 1–5. https://doi.org/10.1038/npjbcancer.2016.26
Artioli, G., Cosentino, C., Taffurelli, C., Ferri, P., & Foà, C. (2019). The narrative interview for the assessment of the assisted person: Structure, method, and data analysis. Acta Biomedica, 90(6-S), 7–16. https://doi.org/10.23750/abm.v90i6-S.8640
Artioli, G., Deiana, L., Bertuol, M., Casella, G., Guasconi, M., Foà, C., et al. (2024). Evaluating a nurse-led narrative interview intervention with cancer patients with a first diagnosis: A feasibility study. Heliyon, 10(11), e30547. https://doi.org/10.1016/j.heliyon.2024.e31802
Audulv, Å., Westergren, T., Ludvigsen, M. S., Pedersen, M. K., Fegran, L., & Hall, E. O. C. (2023). Time and change: A typology for presenting research findings in qualitative longitudinal research. BMC Medical Research Methodology, 23(1), Article 58. https://doi.org/10.1186/s12874-023-02105-1
Bert, G. (2007). Medicina narrativa: Storie e parole nella relazione di cura. Il Pensiero Scientifico.
Braun, V., & Clarke, V. (2019). Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health, 11(4), 589–597. https://doi.org/10.1080/2159676X.2019.1628806
Braun, V., & Clarke, V. (2021). Thematic analysis: A practical guide. SAGE.
Braun, V., & Clarke, V. (2024). Supporting best practice in reflexive thematic analysis reporting in palliative medicine. Palliative Medicine, 38(6), 608–616. https://doi.org/10.1177/02692163241234800
Brogan, P., Hasson, F., & McIlfatrick, S. (2019). Lessons learnt: Examining the use of case study methodology for nursing research in palliative care. Journal of Research in Nursing, 24(6), 446–459. https://doi.org/10.1177/1744987119867737
Bracken, R. C. (2021). Reflective practice in medical education. In P. Crawford & P. Kadetz (Eds.), Palgrave encyclopedia of the health humanities (pp. 1–7). Springer.
Bury, M. (1982). Chronic illness as biographical disruption. Sociology of Health & Illness, 4(2), 167–182.
De Vincentis, G., Monari, F., Baldari, S., Salgarello, M., Frantellizzi, V., & Salvi, E. (2018). Narrative medicine in metastatic prostate cancer. Future Oncology, 14(27), 2821–2832. https://doi.org/10.2217/fon-2018-0318
Egnew, T. R. (2018). A narrative approach to healing chronic illness. Annals of Family Medicine, 16(2), 160–165. https://doi.org/10.1370/afm.2182
Gaikwad, P. (2017). Including rigor and artistry in case study as a strategic qualitative methodology. The Qualitative Report, 22(13), 3431–3446.
Ghodraty-Jabloo, V., Alibhai, S. M. H., Breunis, H., & Puts, M. T. E. (2016). Coping with long-term effects of acute myeloid leukemia. Supportive Care in Cancer, 24(5), 2035–2045. https://doi.org/10.1007/s00520-015-3002-4
Gregorio, C., Spreafico, M., D’Amico, S., Sauta, E., Asti, G., Lanino, L., et al. (2024). Personalized timing for allogeneic stem-cell transplantation. JCO Clinical Cancer Informatics, 8, e2300205. https://doi.org/10.1200/CCI.23.00205
Groleau, D., Young, A., & Kirmayer, L. J. (2006). The McGill Illness Narrative Interview (MINI). Transcultural Psychiatry, 43(4), 671–691. https://doi.org/10.1177/1363461506070796
Herrmann, A., Mansfield, E., Tzelepis, F., Lynagh, M., & Hall, A. (2020). Haematological cancer survivors’ unmet needs. BMC Health Services Research, 20(1), Article 1062. https://doi.org/10.1186/s12913-020-05927-7
Houghton, C., Casey, D., Shaw, D., & Murphy, K. (2013). Rigour in qualitative case-study research. Nurse Researcher, 20(4), 12–17. https://doi.org/10.7748/nr2013.03.20.4.12.e326
Lekarakou, C. E., Koulierakis, G., & Pontikoglou, C. G. (2024). Illness perceptions and illness outcomes in patients with hematologic diseases. Psychology, 15(4), 444–462. https://doi.org/10.4236/psych.2024.154028
LeBlanc, T. W., Fish, L. J., Bloom, C. T., El-Jawahri, A., Davis, D. M., & Locke, S. C. (2017). Patient experiences of acute myeloid leukemia. Psycho-Oncology, 26(12), 2063–2068. https://doi.org/10.1002/pon.4309
Nissim, R., Zimmermann, C., Minden, M., Rydall, A., Yuen, D., & Mischitelle, A. (2013). Abducted by the illness. Leukemia Research, 37(5), 496–502. https://doi.org/10.1016/j.leukres.2012.12.007
Paul, T. K., Reddy, Y., Gnanakumar, A., England, R., Superdock, A., & Malipeddi, D. (2024). Narrative medicine interventions for oncology clinicians. Supportive Care in Cancer, 32(4), Article 241. https://doi.org/10.1007/s00520-024-08434-1
Schlunegger, M. C., Zumstein-Shaha, M., & Palm, R. (2024). Methodologic and data-analysis triangulation in case studies. Western Journal of Nursing Research, 46(8), 611–622. https://doi.org/10.1177/01939459241263011
Shah, R., Finlay, A. Y., Ali, F. M., Allen, H., Nixon, S. J., & Nixon, M. (2024). Burden of hematological conditions on partners. European Journal of Haematology, 113(1), 117–126.
Sibbald, S. L., Paciocco, S., Fournie, M., Van Asseldonk, R., & Scurr, T. (2021). Enhancing case study methodology in health services research. Healthcare Management Forum, 34(5), 291–296. https://doi.org/10.1177/08404704211028857
Slocum, R. B., Howard, T. A., & Villano, J. L. (2017). Narrative medicine in neuro-oncology. Journal of Neuro-Oncology, 134(2), 417–421. https://doi.org/10.1007/s11060-017-2542-5
Tsatsou, I., Konstantinidis, T., Kalemikerakis, I., Adamakidou, T., Vlachou, E., & Govina, O. (2021). Unmet supportive care needs in hematologic malignancies. Asia-Pacific Journal of Oncology Nursing, 8(1), 5–17. https://doi.org/10.4103/apjon.apjon_41_20
Tuck, C. Z., Akparibo, R., Gray, L. A., Suraj, H., Iddrisu, A. R. T., & Abane, T. R. (2025). Lived experiences of patients with cancer in Ghana. BMJ Open, 15, e093303. https://doi.org/10.1136/bmjopen-2024-093303
Turner, A. F., Cowan, H. R., Otto-Meyer, R., & McAdams, D. P. (2024). The emotional impact of the life story interview. Narrative Inquiry, 34(1), 1–29. https://doi.org/10.1075/ni.19109.tur
Wei, H., Mi, Y., Wang, Y., Jiang, E., Hu, J., & Yan, X. (2024). CACA guidelines for holistic integrative management of adult AML. Holistic Integrative Oncology, 3(1), Article 12. https://doi.org/10.1007/s44178-022-00020-x
Wen, B., Liu, Y., Min, X. X., & Wang, A. Q. (2024). Narrative nursing intervention in lung cancer patients. World Journal of Clinical Cases, 12(1), 76–85. https://doi.org/10.12998/wjcc.v12.i1.76
Winestone, L. E., Wilkes, J. J., Puccetti, D., Keegan, T. H. M., Henk, H. J., & McPheeters, J. (2024). Time to diagnosis among young cancer patients. Pediatric Blood & Cancer, 71(9), e30997. https://doi.org/10.1002/pbc.30997
Yin, R. K. (2017). Case study research and applications (6th ed.). SAGE.
Zhang, L., Han, Q., Nan, L., & Yang, H. (2024). Barriers and facilitators to narrative nursing implementation. Medicine, 103(40), e39922. https://doi.org/10.1097/MD.0000000000039922
Zheng, Y. (2024). Effect of narrative nursing intervention on digestive tract malignancies. International Journal of General Medicine, 17, 5747–5756. https://doi.org/10.2147/IJGM.S489001
Zocher, U., Bertazzi, I., Colella, E., Fabi, A., Scarinci, V., & Franceschini, A. (2020). Applicazione della medicina narrativa in oncologia. Recenti Progressi in Medicina, 111(3), 154–160. https://doi.org/10.1701/3315.32857
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2025 © The Author(s) 2025.