Author
MCKEOWN Jane; CLARKE Amanda; REPPER Julie;
Life story work in health and social care: systematic literature review.
Journal citation/publication details
Journal of Advanced Nursing, 55(2), July 2006, pp.237-247.
Summary
Fourteen research and evaluation studies of life story work (LSW), mostly small scale and all involving older people, are reviewed. The authors note methodological limitations and gaps in the evidence base, and comment on the inadequacy of current appraisal tools when assessing qualitative research. LSW has potential benefits for patients, their families and carers, and staff, but also has potential disadvantages as well as resource implications. The overall verdict is a positive one, but with caveats about the quality of existing evidence and the need for health and social care organisations to develop a well thought out strategy before embarking on LSW.
Context
LSW is a term used to describe biographical approaches within health and social care that give people an opportunity to talk about their life experiences. It has been used with a wide variety of groups – children, older people, learning disabled people – and studies suggest that it can have positive benefits, for example in challenging stereotypical attitudes on the part of professionals, contributing to person-centred care and helping in transitions between different care environments. To date there has been no systematic assessment of the literature on LSW, and this review aims to fill that gap.
Methods
What sources were used?
CINAHL (Cumulated Index of Nursing and Allied Health Literature), Medline, ASSIA (Applied Social Science Index and Abstracts), PsycINFO, British Nursing Index, Social Science Citation Index, SIGLE (System for Information on Grey Literature in Europe ), HMIC (Health Management Information Consortium) Database, NHS National Research Register and Index to Theses. The reference lists of retrieved articles were followed up, the Internet was searched using the meta-search engine Copernic, and ‘key people' were contacted for details of on-going work.
What search terms/strategies were used?
Free text and thesaurus ‘intervention' terms (such as ‘life stor*, biograph*, reminisce*) were combined with free text and thesaurus ‘population' terms (such as ‘client*, user*, patient*). There were no date, language or study type restrictions.
What criteria were used to decide on which studies to include?
Studies were included if LSW or biographical approaches were the primary intervention with groups using health and/or social care. There is no commonly agreed definition of LSW but, for the purposes of the review, it was taken to be an umbrella term describing interventions in health or social care practice (such as biography, life story, life history) that are undertaken to elicit an account of some aspect of a person's life and go beyond routine assessment for care or treatment planning.
Who decided on their relevance and quality?
The initial searches yielded over 1,000 references, whose titles and abstracts were screened by two of the authors (unnamed). Those discussing LSW were retrieved and read in full, screened against the inclusion criteria, and sorted into categories adapted from the work of Polit and Hungler (1999), i.e. research papers, evaluations, theoretical, practice guides, and clinical descriptions. Only research and evaluation papers were reviewed, and were assessed using an adapted version of the set of ‘reflective questions' proposed by Popay et al (1998) and Jones (2004) to help in the appraisal of qualitative research. Responsibility for this process is not indicated.
How many studies were included and where were they from?
Fourteen research and evaluation studies, with methodological approaches summarised in Table 2. All relate to older people. Six were from the UK , three from the USA , two from Northern Ireland , one from Scotland and one from Sweden .
How were the study findings combined?
The review is narrative, focusing on broad themes.
Findings of the review
All of the studies are small scale and use qualitative methods, although two also contain a quantitative element. Only one describes the methods used in any depth, and only one includes an explicit statement of the ‘author's position and influence', a factor that could affect both participants and results. The approach to ethical issues is also inconsistent.
All of the studies represent LSW as ‘mostly positive', while admitting that it is not suitable for everyone, and the authors argue that there is ‘a lack of critical debate about the use of LSW in practice'.
Purposes, contexts and client groups
LSW has been used with a variety of aims in mind (summarised in Table 3), including helping to uncover or preserve identity, improving quality of life and influencing the discourse of care. There is no ‘ideal' way of using LSW, and no single approach has been assessed as any more effective than any other. However, life story books are the most widely used method.
The meaning of life story work
The research is ‘relatively rich' in information about the meaning of LSW for care staff, but less so for patients and their families or carers. These meanings are summarised in Table 4. LSW is valued among staff for its capacity to humanise people, and to enable their carers to see beyond medical or social labels such as ‘demented' or ‘learning disabled'. Some studies report changes in care practices as a result. Patients generally describe LSW as enjoyable, as much for its companionable, social aspects as for its intrinsic nature, and families also appreciate the investment by staff in their relatives during LSW. Improved communication and relationships between staff and families were also reported as a beneficial outcome of LSW. However, staff sometimes found the repetition of stories from patients with memory problems ‘emotionally draining', while they were aware that LSW is not for everyone if the recalling of past events causes confusion or distress.
Ethical issues
While patients may find LSW enjoyable, not all are happy for their accounts to be written down, or may change their minds at a later date. The need to be explicit about LSW, and to have confidentiality safeguards in place, is stressed. Particular problems in this context may arise with patients who have communication or cognitive difficulties.
Authors' conclusions
Although LSW has potential benefits for staff, patients and their families, it also has limitations and resource implications (usefully summarised, by study, in Table 5). In addition, both high quality research and tools for appraising it effectively are lacking. Conclusions are therefore ‘tentative'. More research is needed to compare the different goals and methods of LSW, and to explore the impact of LSW on patients and their families, staff attitudes and relationships between staff, patients and relatives.
Implications for policy or practice
‘Life story work is a complex activity and should not be implemented on a large scale without a well thought out strategy'. This needs to address management support and investment in staff support and training; the development of protocols for obtaining consent to engagement in LSW and agreeing ownership of, and access to, the ‘product'; and implementation as part of an overall philosophy rather than simply another task.
Related references
None