# Scaffolding patient agency: Conceptualising readers’ cognitive work in the comic gutter

## TL;DR

This paper explores how comics can help palliative care patients regain a sense of agency through deep engagement in the spaces between panels, known as the gutter.

## Contribution

The novel contribution is the conceptualization of the comic gutter as a liminal space that fosters reflexivity and imagination in patients.

## Key findings

- The comic gutter serves as a space for deep reader engagement that supports agential self-redevelopment.
- Using Bob’s comic, the study shows how the gutter enhances patients’ ability to lead agential change.
- The approach has implications for improving palliative care practice through storytelling.

## Abstract

A life-limiting illness can erode an individual’s positive sense of self. Storytelling can help counteract this, through scaffolding patients’ agency and supporting them in acting to change something which matters to them. This article explains how visual stories – comics – are used within the PATCHATT intervention to support the redevelopment of a person’s agential self. Through the provision of a conceptual map, this article explores the gutter as a liminal space, arguing for the importance of the deep reader engagement which takes place there. It uses Bob’s comic, a story used within PATCHATT, to explore how reflexivity and imagination work together within the liminal space of the gutter to stimulate and enhance palliative care patients’ agential change leadership. It concludes by considering the implications of the argument put forward for palliative care practice.