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.
- critical care
- palliative care
- Spiritual care
- narrative medicine
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Contributors All authors designed the study. All authors except MV and MG participated in the design and implementation of the intervention and/or data collection. MV, FT, MG, MS and DC participated in data analysis and interpretation. MV, FT, MS and DC drafted the manuscript. All authors have critically reviewed the manuscript and given approval to submit the final version.
Funding The Hamilton Academy of Health Sciences Organization and Canadian Intensive Care Foundation, Hamilton Canadian Tire Foundation and a Foundation Grant from the Canadian Institutes of Health Research.
Disclaimer The funders played no role in the design, conduct or reporting of this study.
Competing interests None declared.
Patient consent Obtained.
Ethics approval Hamilton Integrated Research Ethics Board in Hamilton, Ontario.
Provenance and peer review Not commissioned; externally peer reviewed.
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