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

Abstract

ObjectiveThe 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.DesignWord 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.ResultsThe 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.ConclusionsIn 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.

Expanding the 3 Wishes Project for compassionate end-of-life care: a qualitative evaluation of local adaptations

“…A strictly protocolized program would likely inhibit individuals from identifying creative ways of relating to each other, potentially reducing the value of human connections realized through the program. Current and previous research about 3WP has found the meaning of these human connections to be one of the most important strengths of the program [6,7,[9][10][11]21].…”

“…While not planned a priori, this analysis describes how the 3WP was initiated and eventually integrated organically into practice without a rigid protocol in 9 ICUs with their own culture in Canada and the United States. Family perspectives, though previously obtained about different aspects of this program [6,7,[9][10][11], were not sought about program implementation; thus, neither family nor deceased patient perspectives are included here.…”

“…Today, the 3 Wishes Project has not only become embedded into the culture of end-of-life care in the original unit, but thrives in over 20 ICUs across North America in a variety of formats ranging from research project to clinical program. Through a variety of mixed-methods studies, we have demonstrated the impact of the 3WP as experienced by families, clinicians, and trainees [6][7][8][9][10][11]. Recently, we published a multicenter formative program evaluation of the 3WP in 4 hospitals, demonstrating it is a transferrable, affordable, and sustainable end-of-life care program that provides value to families, clinicians, and the institution [9].…”

Obtención automática de palabras clave en textos clínicos: una aplicación de procesamiento del lenguaje natural a datos masivos de sospecha diagnóstica en Chile

“…Las nubes de palabras se utilizan para la comunicación de palabras clave y ejemplos de su uso son el refuerzo a las familias de pacientes fallecidos que han sido tratados mediante un enfoque de medicina narrativa 14 ; como forma de resumir los artículos publicados en revistas científicas en función de los años 26 y para el análisis de datos clínicos cualitativos 27 .…”

“…Las nubes de palabras son colecciones de vocablos organizados en forma compacta, en donde el tamaño de la fuente codifica la relevancia de cada palabra en el documento 14,15 . Para la generación de las nubes de palabras se mapeó el valor de FT-FID de la palabra al tamaño de esta.…”