Cindy Smalletz, OTR/L, BCB

Charon, R., Irvine, C., Oforlea, A.N., Colón, E.R., Smalletz, C., & Spiegel, M. (2021). Racial Justice in Medicine: Narrative Practices toward Equity. Narrative 29(2), 160-177. doi:10.1353/nar.2021.0008.

ABSTRACT:
In an age of police violence against Black persons and their mass incarceration, Americans seek a "public sphere" in which to examine the torn fabric of race relations. To date, efforts to overcome centuries-long polarizations and to find collective avenues toward racial… Show more

Charon, R., Irvine, C., Oforlea, A.N., Colón, E.R., Smalletz, C., & Spiegel, M. (2021). Racial Justice in Medicine: Narrative Practices toward Equity. Narrative 29(2), 160-177. doi:10.1353/nar.2021.0008.

ABSTRACT:
In an age of police violence against Black persons and their mass incarceration, Americans seek a "public sphere" in which to examine the torn fabric of race relations. To date, efforts to overcome centuries-long polarizations and to find collective avenues toward racial justice have had little success. This essay proposes that narrative engagement and creative discovery can open paths toward mutual comprehension, if not reconciliation, in the sphere of racial justice.

Focusing on racial inequity within health care, faculty from the Division of Narrative Medicine at Columbia University designed and executed an intensive three-day workshop entitled "Race | Violence | Justice: The Need for Narrative" using the methods and principles of narrative medicine. This essay provides a critical race theory conceptual framework for the project and summarizes the content and process of the workshop itself. To learn about the workshop's outcomes, the 110 participants were surveyed anonymously six months later in an unsolicited email questionnaire composed of three open-ended questions and a creative exercise. The team accomplished a modified-grounded-theory–guided content analysis of the survey question responses and a narrative/poetics reading of the responses to the creative exercise.

The study identified overarching themes and revealed uniform and enthusiastic endorsement of the methods of the workshop with evidence of lasting impact on respondents' work, teaching, activism, and personal lives. Although limited by the number of participants and respondents, the study supports the necessity of narrative and creative approaches in anti-racism and anti-bias work. Show less

How can nurses, doctors, social workers, and therapists comprehend what their patients experience with illness? How can we develop a recognition of each patient’s individual situation? Answers to these questions are emerging from the fields of narrative medicine and medical humanities that explore the ways of knowing the world from literature, philosophy, and the creative arts. Narrative Medicine is a health care practiced with narrative competence and an understanding of these highly complex… Show more

How can nurses, doctors, social workers, and therapists comprehend what their patients experience with illness? How can we develop a recognition of each patient’s individual situation? Answers to these questions are emerging from the fields of narrative medicine and medical humanities that explore the ways of knowing the world from literature, philosophy, and the creative arts. Narrative Medicine is a health care practiced with narrative competence and an understanding of these highly complex situations among clinicians, patients, colleagues, and the public. Recognizing clinical care as a narrative practice fortified by learnable skills in understanding stories has helped to face otherwise difficult problems in clinical practice and education in the areas of professionalism, reflective practice, patient-centered care, and self-awareness. In this lecture, the principles and methods of narrative medicine will be introduced and explored. Close reading of a literary text or piece of art followed by narrative writing is a way to make seen and heard what otherwise would pass without notice. Doing this work together with narrative and art allows for surprise and discovery, team affiliation, and encourages us to enact a vision for better patient care. Show less

Health humanities education traditionally takes place in an in-person, classroom setting. However, this type of education is not as widely accessible because of location and scheduling limitations. At Columbia University, we recently developed an online asynchronous certificate program in Narrative Medicine to spread this education and make it more available to health humanities practitioners. In the last two decades, Narrative Medicine principles and practices have emerged as an innovation in… Show more

Health humanities education traditionally takes place in an in-person, classroom setting. However, this type of education is not as widely accessible because of location and scheduling limitations. At Columbia University, we recently developed an online asynchronous certificate program in Narrative Medicine to spread this education and make it more available to health humanities practitioners. In the last two decades, Narrative Medicine principles and practices have emerged as an innovation in building active listening and interpersonal skills, and thereby the clinical capacity of medical professionals in practice and training (Charon, et al., 2017). Digitalizing a traditionally embodied approach to health humanities has created a unique learning experience. The in-person connection that is traditionally the crux of our field is replaced by asynchronous online discussions. Each discussion has a written archive, allowing more time for reflection and giving all students an equal voice. The assignments foster critical thinking as the courses require students to create, synthesize and integrate what they are being taught with their own lives (Harris, Mishra, & Koehler, 2009; Simonson et al., 2012). Instead of traveling to the course, the course travels with the students and they draw connections with their lived experiences. This type of program has allowed students to join together across time zones, continents, and disciplines to form interprofessional relationships and take part in education that might not otherwise be possible. Our online program provides flexibility needed for the contemporary learner, while retaining the components necessary for an academically rigorous health humanities education. Show less

Background:
Breast cancer risk assessment including genetic testing can be used to classify people into different risk groups with screening and preventive interventions tailored to the needs of each group, yet the implementation of risk-stratified breast cancer prevention in primary care settings is complex.

Objective:
To address barriers to breast cancer risk assessment, risk communication, and prevention strategies in primary care settings, we developed a Web-based decision… Show more

Background:
Breast cancer risk assessment including genetic testing can be used to classify people into different risk groups with screening and preventive interventions tailored to the needs of each group, yet the implementation of risk-stratified breast cancer prevention in primary care settings is complex.

Objective:
To address barriers to breast cancer risk assessment, risk communication, and prevention strategies in primary care settings, we developed a Web-based decision aid, RealRisks, that aims to improve preference-based decision-making for breast cancer prevention, particularly in low-numerate women.

Results:
Among 34 participants, mean age was 53.4 years, 62% (21/34) were Hispanic, and 41% (14/34) demonstrated low numeracy. According to the Gail breast cancer risk assessment tool (BCRAT), the mean 5-year and lifetime breast cancer risk were 1.11% (SD 0.77) and 7.46% (SD 2.87), respectively. After interacting with RealRisks, the difference in perceived and estimated breast cancer risk according to BCRAT improved for 5-year risk (P=.008). In the qualitative analysis, we identified potential barriers to adopting risk-appropriate breast cancer prevention strategies, including uncertainty about breast cancer risk and risk models, distrust toward the health care system, and perception that risk assessment to pre-screen women for eligibility for genetic testing may be viewed as rationing access to care.

Conclusions:
In a multi-ethnic population, we demonstrated a significant improvement in accuracy of perceived breast cancer risk after exposure to RealRisks. However, we identified potential barriers that suggest that accurate risk perceptions will not suffice as the sole basis to support informed decision making and the acceptance of risk-appropriate prevention strategies. Findings will inform the iterative design of the RealRisks decision aid. Show less

Yi, Haeseung & Xiao, Tong & S. Thomas, Parijatham & Aguirre, Alejandra & Smalletz, Cindy & Dimond, Jill & Finkelstein, Joseph & Infante, Katherine & Trivedi, Meghna & David, Raven & Vargas, Jennifer & Crew, Katherine & Kukafka, Rita. (2015). Barriers and

"Engaging Pediatric Dentists with Registered Dietitians to Improve Children's Oral Health and Dental Care." Journal of the Academy of Nutrition and Dietetics - September 2013 (Vol. 113, Issue 9, Supplement, Page A94, DOI: 10.1016/j.jand.2013.06.333)

Office of National Coordinator. (2010). Health information technology-Columbia University (1U24OC000003). Washington, DC.