Narrative medicine and death in the ICU: word clouds as a visual legacy.

OBJECTIVE The Word Cloud is a frequent wish in the 3 Wishes Project developed to nurture peace and ease the grieving process for dying critically ill patients. The objective was to examine whether Word Clouds can act as a heuristic approach to encourage a narrative orientation to medicine. Narrative medicine is an approach which can strengthen relationships, compassion and resilience. DESIGN Word Clouds were created for 42 dying patients, and we interviewed 37 family members and 73 clinicians about their impact. We conducted a directed qualitative content analysis, using the 3 stages of narrative medicine (attention, representation, affiliation) to examine the narrative medicine potential of Word Clouds. RESULTS The elicitation of stories for the Word Cloud promotes narrative attention to the patient as a whole person. The distillation of these stories into a list of words and the prioritisation of those words for arrangement in the collage encourages a representation that did not enforce a beginning, middle or end to the story of the patient's life. Strong affiliative connections were achieved through the honouring of patients, caring for families and sharing of memories encouraged through the creation, sharing and discussion of Word Clouds. CONCLUSIONS In the 3 Wishes Project, Word Clouds are 1 way that families and clinicians honour a dying patient. Engaging in the process of making a Word Cloud can promote a narrative orientation to medicine, forging connections, making meaning through reminiscence and leaving a legacy of a loved one. Documenting and displaying words to remember someone in death reaffirms their life.

[1]  D. Cook,et al.  Dying with dignity in the intensive care unit. , 2014, The New England journal of medicine.

[2]  L. Lingard,et al.  Exploring the therapeutic power of narrative at the end of life: a qualitative analysis of narratives emerging in dignity therapy , 2011, BMJ Supportive & Palliative Care.

[3]  R. Charon What to do with stories: the sciences of narrative medicine. , 2007, Canadian family physician Medecin de famille canadien.

[4]  M. Vachon,et al.  Self-care of physicians caring for patients at the end of life: "Being connected... a key to my survival". , 2009, JAMA.

[5]  M. Westwood,et al.  Preventing vicarious traumatization of mental health therapists: Identifying protective practices. , 2009, Psychotherapy.

[6]  D. Heels-Ansdell,et al.  Resident reflections on end-of-life education: a mixed-methods study of the 3 Wishes Project , 2016, BMJ Open.

[7]  P. Rosenblatt,et al.  Shared Reminiscence about a Deceased Parent: Implications for Grief Education and Grief Counseling , 1990 .

[8]  R. Charon Narrative Medicine: Attention, Representation, Affiliation , 2005 .

[9]  C. J. Morgenweck Spirituality at the end of life , 2018, Current opinion in anaesthesiology.

[10]  R. Charon,et al.  Narrative Medicine: Form, Function, and Ethics , 2001, Annals of Internal Medicine.

[11]  Samuel M. Brown,et al.  Humanizing Intensive Care: Theory, Evidence, and Possibilities , 2016 .

[12]  William Phillips,et al.  Grief Rituals: Aspects That Facilitate Adjustment to Bereavement , 2003 .

[13]  S. Livigni,et al.  A narrative-based study on communication by family members in intensive care unit. , 2013, Journal of critical care.

[14]  R. Charon Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust , 2001 .

[15]  D. Cook,et al.  Personalizing Death in the Intensive Care Unit: The 3 Wishes Project , 2015, Annals of Internal Medicine.

[16]  A. Parsons,et al.  Dignity and Narrative Medicine , 2010 .