title: Narrative medicine and death in the ICU: word clouds as a visual legacy.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Meredith
authors.initials: M
authors.lastname: Vanstone
authors.affiliation: Spiritual Care St Joseph's Healthcare, Hamilton, Ontario, Canada.
authors.forename: Feli
authors.initials: F
authors.lastname: Toledo
authors.affiliation: Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.|Department of Medicine, McMaster University, Hamilton, Ontario, Canada.|Department of Critical Care, St Joseph's Healthcare, Hamilton, Ontario, Canada.
authors.forename: France
authors.initials: F
authors.lastname: Clarke
authors.affiliation: Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.|Department of Medicine, St Joseph's Healthcare, Hamilton, Ontario, Canada.
authors.forename: Anne
authors.initials: A
authors.lastname: Boyle
authors.affiliation: Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Mita
authors.initials: M
authors.lastname: Giacomini
authors.affiliation: Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Swinton
authors.affiliation: Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Lois
authors.initials: L
authors.lastname: Saunders
authors.affiliation: Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Melissa
authors.initials: M
authors.lastname: Shears
authors.affiliation: Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Nicole
authors.initials: N
authors.lastname: Zytaruk
authors.affiliation: Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.|Department of Medicine, St Joseph's Healthcare, Hamilton, Ontario, Canada.
authors.forename: Anne
authors.initials: A
authors.lastname: Woods
authors.affiliation: Spiritual Care St Joseph's Healthcare, Hamilton, Ontario, Canada.
authors.forename: Trudy
authors.initials: T
authors.lastname: Rose
authors.affiliation: Spiritual Care St Joseph's Healthcare, Hamilton, Ontario, Canada.
authors.forename: Tracey
authors.initials: T
authors.lastname: Hand-Breckenridge
authors.affiliation: Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Diane
authors.initials: D
authors.lastname: Heels-Ansdell
authors.affiliation: Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Shelley
authors.initials: S
authors.lastname: Anderson-White
authors.affiliation: Department of Emergency Medicine, North Cypress Medical Center, Cypress, Texas, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Sheppard
authors.affiliation: Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.|Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Deborah
authors.initials: D
authors.lastname: Cook
keywords: Spiritual care; critical care; dying; narrative medicine; palliative care