Dr Fei Li explores the integration of narrative medicine and palliative care at Peking Union Medical College in China.
Beginning
I became a lecturer at Peking Union Medical College in 2010. A trained anthropology in medical school, I find myself a twofold mission: to observe how medicine operates and to help medical students become good health caregivers. The first objective leads me to a long-term fieldwork in the Palliative Medicine Center at Peking Union Medical College Hospital (PUMCH), where I gather firsthand materials from frontline responders. For the second objective, I conduct surveys and in-depth interviews with graduated medical students focusing on motivation to study medicine and their growth crisis stories. As I pursue both directions, I gradually recognize that sometimes simple listening would be a good and necessary way to make a huge difference. Listening fosters acknowledgement, reflection, communication, trust, and pathways to actions. After years of explorations, I’ve developed this sense but I was not sure about how to explain it until I came across narrative medicine.
Narrative medicine entered in China in 2011 (Guo and Wang, 2019). The most influential theory of narrative medicine in the Chinese context comes from Dr. Rita Charon, who defines narrative medicine as medicine practised with these narrative skills of recognising, absorbing, interpreting, and being moved by the stories of illness and later as a comprehensive practice model (Charon 2001; 2006). The theory instantly caught my attention and linked my fieldwork observations with my teaching experience. In 2017, I developed a course on narrative medicine mainly using materials collected from palliative care practices. Built on a 9-year long exploration, I integrate narrative medicine and palliative care and termed it as “narrative palliative care.”
An Emerging Interdisciplinary Field
Narrative palliative care refers to the practice of palliative care based on narrative medicine principles and tools (Li, Wang, Ning, 2022). The field intersects areas of anthropology, narrative medicine, and palliative care. Narrative palliative care engages critically with the foundational structures of narrative medicine, positioning narrative theory as both the epistemological core and the conceptual fulcrum from which a humanistic framework for palliative care might be articulated. Narrative medicine can inform and transform the practice of palliative medicine by paying special attention to the ontological significance of storytelling in clinical practice and the integrative role of literary discourse in shaping empathic care.
The integration of narrative medicine and palliative care has emerged as a particularly influential force in contemporary medical education, generating positive feedback from both learners and practitioners. As Stanley and Hurst (2011) illustrate, a discussion of narrative competence—encompassing the skills of attention, representation, and affiliation—provides the foundation for a structured narrative medicine workshop. This also includes a detailed analysis of experiential exercises in close reading and reflective writing. More recently, narrative interventions have been actively evaluated for their potential to improve communication and well-being among parties involved in palliative and end-of-life care (Laskow et al., 2019).
In clinical practice, narrative palliative care finds its most tangible expression in the use of narrative medical records—standard medical charts incorporating narrative content. The concept of narrative medical records draws inspiration from the parallel chart framework advocated by Dr. Charon, but it is different from it. While parallel charts promote a narrative mindset in medical documentation by inviting reflective writing that captures patients’ stories, emotions, and lived experiences as supplements to the formal medical record (Charon, 2006), they remain distinct, supplementary texts. By contrast, the concept of narrative medical records that I advocate is a modification of the standard clinical record. It integrates narrative content directly alongside clinical data, seeking to develop a transferable methodology rooted in palliative care but applicable across broader medical settings.
Specialised records and documentation are particularly important for palliative care, whose aim is less to cure but to care. The integration of narrative medicine and palliative care thus not only bridges the divide between biomedicine and humanistic care but also gestures toward a more empathetic and relational model of clinical engagement. My research has examined the practice of narrative medical records in palliative medicine. This includes a textual analysis of narrative content in consultation records—such as authentic dialogues between clinicians, patients, and family members; emotionally charged language (e.g., “discomfort,” “severe,” “cruel,” “fear”); and the observed gestures and expressions of patients during clinical interactions (e.g., nodding, shaking the head, or ambiguous nonverbal responses) (Li, Ning, Wang, He, 2022). Furthermore, I have investigated the clinical applications of narrative medical records written by different members of the care team, including physicians, nurses, and social workers (Li, 2024), which offer valuable insights into interdisciplinary perspectives and affective labour in the role of narrative documentation during the end-of-life care.
Furthermore, narrative palliative care has pedagogical potential. Recently, cultivating and enhancing narrative competence has become one major goal of medical education in the Chinese context. Clinical cases in narrative palliative care can be used to train medical students with some core capacities—such as attentive observation, empathetic listening, close reading, and reflective writing. Cases in real setting possess educational value and practical applicability for medical students to prepare themselves in highly complicated and emotionally challenging areas such as palliative care. Combined with rich and vivid cases, the integration of multiple approaches such as the interpretation and appreciation of literary text, painting, microfilm, and so on is employed to enrich the training trajectories essential to narrative education in palliative settings. In the practical part of the narrative medicine course, teachers arrange for medical students to complete a half-day hospice volunteer service. They go into ward to observe patients and listen to their stories. This exercise trains the students in observation, listening, communication, and empathy skills; and it is also a precious opportunity to interact with those who are seriously ill.
Scholars understand narrative palliative care from different perspectives. Jing Jun, professor of sociology from Tsinghua University, highlights the use of auto/ethnography in narrative palliative care to create efficacy and close contact between researchers and/or practitioners and the patients and/or participants. Guo Liping, professor of Medical Humanities from Peking University, believes that narrative palliative care expands the horizon of narrative medicine in China and showcases a valuable example of integrating narrative theory with clinical practice. Another sociologist, Dr. Wang Jianli, from the Chinese Academy of Social Sciences, summarizes narrative palliative care as “interactive knowledge”, originating from the in-depth interdisciplinary cooperations between palliative care and narrative medicine.
The clinical reception of narrative palliative care has been notably enthusiastic. Dr. Ning Xiaohong, director of the Palliative Medicine Center at PUMCH, thinks highly of this approach. She regards narrative not only as meaningful story but also as an essential tool in the delivery of palliative care. Her team integrates narrative into their daily routines, exemplified by their use of reflective prompts such as: “What was the patient’s tone and expression at that moment?” Similar inquiries have become standard in the team briefings, as they are considered vital to inform better judgements and care decisions.
Towards the Future
Current theoretical discussions on narrative palliative care focus on whether this emerging field belongs more to the palliative care practice with narrative medicine characteristics, or whether it is a new exploration of narrative medicine in the palliative care context. Either way, narrative palliative care is on the way of establishing itself as one of the latest interdisciplinary enterprises in medicine. Narrative palliative care also corresponds with the narrative turn in Chinese medical humanities, where narrative is considered as a powerful driving force for practising medicine ethically and empathetically. Through mutually generative dialogues between narrative medicine and palliative care, narrative palliative care exemplifies the commitment of medical humanities to actively respond to the evolving needs of medicine and society.
This article introduces the emerging concept of “narrative palliative care,” aiming to contribute both to its theoretical development and to the exploration of practical pathways for its integration within the broader framework of narrative medicine. Given its current limited scope of application, it warrants further empirical validation. It is anticipated that future scholarship will advance this concept through diverse methodological and disciplinary perspectives.
Peking Union Medical College Press, 2025.
About the Author
Fei Li is an associate professor from the School of Humanities and Social Sciences, Peking Union Medical College. Her research interests include medical anthropology, narrative medicine, and medical education. Trained in anthropology, she is the founder and director of the Narrative Medicine course at PUMC. In recent years, she has been committed to the collaborative promotion of narrative medicine education and palliative care practice as well as the localisation research of clinical narrative practices. Her recent monographs include Narrative Palliative Care (2025) and Praising Death (2018).
References
Charon R.2001. “Narrative medicine: form, function, and ethics”. Ann Intern Med, 134 (1):83-87.
Charon R. 2006. Narrative medicine: honoring the stories of illness. Oxford University Press.
Guo, L.P. Wang, Y. F. 2019. Xushi yixue zai woguo de zaidihua fazhan [Localization of narrative medicine in China]. Chinese Medical Ethics. 2019,32 (2):147-152.
Laskow T, Small L, Wu D S. 2019. “Narrative interventions in the palliative care setting: a scoping review”. Journal of Pain and Symptom Management 58 (4): 696-706.
Li, F. 2025. Xushi huanhe yiliao [Narrative palliative care]. Peking Union Medical College Press.
Li, F. Ning, X. H. Wang, J.L. He, Z. 2022. Xushi bingli linchuang yingyong de keneng lujing [Possible approaches to clinical application of narrative medical records]. Medicine and Philosophy 43(06): 46-51.
Li, F. Wang, J.L. Lin, M.L. et al. 2024. Zhaohu gongtongti xushi bingli de linchuang yingyong anli yu fenxi. [Clinical application cases and analysis of narrative medical records within care community]. Chin J Geriatr 43(7): 817-821.
Li, F, Wang, J.L, Ning, X.H. 2022. “Xushi yixue yu huanhe yiliao de xiangrongjiaohui: huanhe yilaio 10nian bitan chengguo zhiyi [The compatibility intersection of narrative medicine and palliative care: the first written talks outcome of the “10 years of Palliative Care”]. Chinese Medical Ethics 35(11):1171-1177.
Stanley P, Hurst M. 2011. “Narrative palliative care: a method for building empathy”. J Soc Work End Life Palliat Care 7(1): 39-55.
