Background: Graphic medicine is defined as the “interaction between the medium of comics and the discourse of healthcare”. We seek to understand the ways in which comics are currently being employed in healthcare settings and what effects, if any, these practices have on physician, patient, and their experiences and health outcomes. Methods: Our scoping review is following the six-stage methodology laid out by Arksey and O’Malley (2005) in order to map the field – an appropriate methodology, as graphic medicine is a relatively new field that thus far lacks clear boundaries. We built, tested, and conducted searches in six databases: (1) PubMed, (2) CINAHL, (3) SCOPUS, (4) ERIC, (5) Web of Science (Core), and (6) Google Scholar. Preliminary Findings: Search results netted 5,097 unique citations, which highlights a clear problem with current indexing of comics in medical databases, as at least 80% of the citations were in fact NOT comics at all. In-depth screening and analysis of relevant results is ongoing. Potential Impact: Graphic medicine shows potential as a tool in medical and patient education and may help bridge the health literacy gap. Next Steps: Our next steps include synthesis of relevant studies and ongoing hand-searching for results outside of typical scholarly publications. Questions for the MTL Community: How might you make use of comics in your practice and/or praxis?

BACKGROUND: The success of a facilitator-based model for advance care planning (ACP) in LaCrosse, Wisconsin, has inspired health systems to aim for widespread documentation of advance directives, but limited resources impair efforts to replicate this model. One promising strategy is the development of interactive, Internet-based tools that might increase access to individualized ACP at minimal cost. However, widespread adoption and implementation of Internet-based ACP efforts has yet to be described. OBJECTIVE: We describe our early experiences in building a systematic, population-based ACP initiative focused on health system-wide deployment of an Internet-based tool as an adjunct to a facilitator-based model. METHODS: With the sponsorship of our healthcare system's population health leadership, we engaged a diverse group of clinical stakeholders as champions to design an Internet-based ACP tool and facilitate local practice change. We describe how we simultaneously began to train clinicians in ACP conversations, engage patients and health system employees in thinking about ACP, redesign clinic workflows to accommodate ACP discussions, and integrate the Internet-based tool into the electronic medical record (EMR). RESULTS: Over 18 months, our project engaged two subspecialty clinics in a systematic ACP process and began work with a large primary care practice with a large Medicare Accountable Care Organization at-risk population. Overall, 807 people registered at the Internet site and 85% completed ACPs. CONCLUSION: We learned that changing culture and systems to promote ACP requires a comprehensive vision with simultaneous, interconnected strategies targeting patient education, clinician training, EMR documentation, and community awareness.

BACKGROUND: Burnout, stress and anxiety have been identified as areas of concern for informal caregivers and health professionals, particularly in the palliative setting. Meditative interventions are gaining acceptance as tools to improve well-being in a variety of clinical contexts, however, their effectiveness as an intervention for caregivers remains unknown. AIM: To explore the effect of meditative interventions on physical and emotional markers of well-being as well as job satisfaction and burnout among informal caregivers and health professionals. DESIGN: Systematic review of randomised clinical trials and pre-post intervention studies with meditative interventions for caregivers. DATA SOURCES: PubMed, EMBASE, CINAHL and PsycINFO were searched up to November 2013. Of 1561 abstracts returned, 68 studies were examined in full text with 27 eligible for systematic review. RESULTS: Controlled trials of informal caregivers showed statistically significant improvement in depression (effect size 0.49 (95% CI 0.24 to 0.75)), anxiety (effect size 0.53 (95% CI 0.06 to 0.99)), stress (effect size 0.49 (95% CI 0.21 to 0.77)) and self-efficacy (effect size 0.86 (95% CI 0.5 to 1.23)), at an average of 8 weeks following intervention initiation. Controlled trials of health professionals showed improved emotional exhaustion (effect size 0.37 (95% CI 0.04 to 0.70)), personal accomplishment (effect size 1.18 (95% CI 0.10 to 2.25)) and life satisfaction (effect size 0.48 (95% CI 0.15 to 0.81)) at an average of 8 weeks following intervention initiation. CONCLUSIONS: Meditation provides a small to moderate benefit for informal caregivers and health professionals for stress reduction, but more research is required to establish effects on burnout and caregiver burden.

Pain is a multidimensional, complex experience. There are many challenges in identifying and meeting the needs of patients experiencing pain. Evaluation of pain from a bio-psycho-social-spiritual framework is particularly germane for patients approaching the end of life. This review explores the relation between the psychospiritual dimensions of suffering and the experience of physical pain, and how to assess and treat pain in a multidimensional framework. A review of empirical data on the relation between pain and suffering as well as interdisciplinary evidence-based approaches to alleviate suffering are provided.

Pain is a multi-dimensional, complex experience. It is a struggle to adequately identify and meet the needs of patients experiencing pain in a bio-psycho-social–spiritual context. In this chapter we explore the relationship between the spiritual dimensions of suffering and the experience of physical pain. By intertwining research with clinical case studies, the chapter reviews definitions, the relationship between spiritual anguish and physical pain, and finally interdisciplinary and evidence-based approaches to alleviating suffering.

Background: The benefits of exposing hospitalized patients to live music have been well established, both from a quality improvement perspective and as a means of therapy. Hospitals across the country are increasingly seeking to incorporate music into models of patient-centered care. Music offers many benefits to the performer as well, and is well suited for promoting empathic communication, stress relief and a sense of well-being. Medical students in the pre-clinical years who might otherwise experience little patient interaction are able to uniquely engage with patients through musical performance. Purpose: The purpose of this study was to examine the quality improvement impact of a program that facilitated musical performances given by student volunteers to hospitalized patients. Methods: Student musicians were recruited via email from the UMass Medical School and the Graduate School of Nursing, with an initial pool of 47 students expressing interest in performing. Over a period of several months, 21 performances were held on the Oncology floor and in the Bone Marrow Transplant unit. Qualitative data was collected via an online survey from the student volunteers and from the nursing staff. Informal feedback was obtained from patients. Results: The qualitative data collected was almost uniformly positive. Student musicians generally reported positive experiences, and felt that their efforts were appreciated by patients and by the nursing staff. Staff also enjoyed the performances, with most feeling that their workplace environment was positively impacted. Indeed, the major complaint from nursing staff was that the performances were not frequent enough. Although data was not collected from patients, informal questioning indicated that almost all patients enjoyed the experience. Conclusions: Taken as a whole, student musical volunteering in the hospital setting appears to be of great benefit as both a quality improvement tool and as a means of engaging students with patients. Patients appreciate the personal attention and a break from the monotony of hospitalization, while hospital staff reports a more pleasant working environment. Students are able to connect directly with patients in a non-medical role, which can be deeper and more meaningful than a brief encounter during work rounds. Additionally, pre-clinical students are exposed to the hospital setting and to patients.