RT Journal Article SR Electronic T1 Narrative medicine and death in the ICU: word clouds as a visual legacy JF BMJ Supportive & Palliative Care JO BMJ Support Palliat Care FD British Medical Journal Publishing Group SP bmjspcare-2016-001179 DO 10.1136/bmjspcare-2016-001179 A1 Meredith Vanstone A1 Feli Toledo A1 France Clarke A1 Anne Boyle A1 Mita Giacomini A1 Marilyn Swinton A1 Lois Saunders A1 Melissa Shears A1 Nicole Zytaruk A1 Anne Woods A1 Trudy Rose A1 Tracey Hand-Breckenridge A1 Diane Heels-Ansdell A1 Shelley Anderson-White A1 Robert Sheppard A1 Deborah Cook YR 2016 UL http://spcare.bmj.com/content/early/2016/11/24/bmjspcare-2016-001179.abstract 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.