'Word Clouds' comfort families and doctors of dying patients


To humanize the intensive care unit and comfort families of the dying, Canadian doctors have found a way to elicit happier memories at the bedside.

They're creating Word Clouds - and they say the practice is valuable for them, too, because it helps them forge their own bonds with patients.

Staff members in the ICU of St. Joseph's Healthcare in Hamilton, Ontario say the process is an economical way to alleviate a stressful time. They have incorporated Word Cloud creation into regular practice and recently studied its impact.

"It was surprisingly meaningful," said Dr. Meredith Vanstone, an assistant professor of family medicine at McMaster University. She and her colleagues interviewed 37 relatives and 73 healthcare providers of 42 dying patients who were Word Cloud subjects.

The Word Clouds, generated through the website, are graphic representations of descriptions of patients, not just by loved ones but also by the healthcare professionals caring for them.

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They're "a form of art - a 'Picture of Words,'" according to Vanstone and her colleagues.

Word Clouds are "a catalyst for telling stories," Vanstone told Reuters Health. "It's a way to get families away from thinking about negative things going on."

The distillation of stories promotes attention to the patient as a whole person, she said, reflecting a life's entirety during a time when many focus on the details of the final days.

One Word Cloud, for example, contained roughly 50 descriptors (hardworking, best-uncle-ever, Bob-Dylan, fishing and union-man), with the phrases arranged around the patient's name.

Writing in BMJ Supportive and Palliative Care, the authors share a comment about the process from a patient's daughter: ". . . it was more of a family bonding in time of need . . . it's nice to talk about something that brings a smile on your face."

For clinicians in the ICU, which is a stressful place to work, "Word Clouds provide the opportunity to create human connection," said study coauthor France Clarke, also of McMaster University. "They reinvigorate the passion that brought (providers) to this career and do some healing to the people who are around."

The project hinges on the practice of narrative medicine, a care model in which clinicians elicit patient's stories and recognize their common humanity. Narrative medicine, which aims to benefit patients and doctors, was pioneered by Dr. Rita Charon at Columbia University College of Physician and Surgeons in New York City. Charon, who was not involved in this project, calls it "beautiful."

Forging authentic connections among clinicians, patients and families is one of narrative medicine's highest aims, and one Charon says the eliciting of stories for the graphic facilitates this kind of connection.

Providers "get to know the bravery, the reluctance to give up, the eagerness with which they hear footsteps of a visitor," Charon told Reuters Health.

Seeing the image of the Word Cloud was also healing, the study found. Some family members reported looking at them regularly to feel closer to loved ones after their death. "Having it is a chance to reflect and remember," Vanstone said.

"It makes a community among those who are usually pretty separated, the family on one side and the doctors and nurses on the other side who only meet when there is bad news to be had," Charon said. "This is one small example of a much larger mission: to let it be known that physicians care so deeply for what happens to their patients and to learn that that matters."