PT - JOURNAL ARTICLE AU - Meredith Vanstone AU - Feli Toledo AU - France Clarke AU - Anne Boyle AU - Mita Giacomini AU - Marilyn Swinton AU - Lois Saunders AU - Melissa Shears AU - Nicole Zytaruk AU - Anne Woods AU - Trudy Rose AU - Tracey Hand-Breckenridge AU - Diane Heels-Ansdell AU - Shelley Anderson-White AU - Robert Sheppard AU - Deborah Cook TI - Narrative medicine and death in the ICU: word clouds as a visual legacy AID - 10.1136/bmjspcare-2016-001179 DP - 2016 Nov 24 TA - BMJ Supportive & Palliative Care PG - bmjspcare-2016-001179 4099 - http://spcare.bmj.com/content/early/2016/11/24/bmjspcare-2016-001179.short 4100 - http://spcare.bmj.com/content/early/2016/11/24/bmjspcare-2016-001179.full AB - 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.