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Introduction 28 A clown is an artistic figure that is always surrounded by the unexpected and knows how to make the 29 most of every annoyance. A performer characterized by provoking failures but also overcoming 30 them, playing with imagination and poetics. The clown is a character firmly situated in the present 31 who always exhibits a contrast, either through their image or their actions, consequently achieving 32 laughter and humor. Around fifty years ago they began to move from the stage, to visit places where 33 2 healthcare was offered (Spitzer, 2006), thanks to their ability to sensitively listen to people and 34 creatively communicate in both verbal and non-verbal ways. 35Clowns are also symbols of human vulnerability who empathize with patient uncertainty, cope with 36 and fight stress, anxiety, and pain (Fusetti et al., 2022). Thus, they evolved to become known as 37 clown doctors, hospital clowns, healthcare, or therapeutic clowns. The effect of these professionals 38 has been evaluated and studied in various populations, medical contexts and measures, confirming 39 their impact and supporting this type of intervention, and they are now established figures in the Clowns can find laughter on many occasions, breaking the tension and stress present in these spaces 125 using the unexpected contrast of humor, but never forcing it. What happens is always done with 126 sensitivity and their capacity to build a shared expression. 127Healthcare clowns employ several skills to enhance communication, which is especially suitable 129 when interacting with patients who have verbal impairments. This is illustrated first by their 130 proficiency in using non-verbal expressiveness and gestures. Secondly, communication happens 131 using music: bringing songs that are meaningful to patients into the hospital or leveraging their high 132 sensitivity to listen and respond to the rhythms of the space in accordance with the tempo of the 133 interaction established between the interlocutors. A third benefit lies in establishing communication 134 through the gaze and basic emotional expressions, which also stimulates expression of other's 135 emotions. 136This becomes especially relevant when considering older adults receiving oncological and palliative 137 care, who may also be experiencing dementia or speech problems derived from neurological damage. 138This was demonstrated using an ethogram of micro-gestures, which found a significant increase in 139 the older population's communicative intent in interactions with healthcare clowns (Pérez-González 140 and Carnero-Sierra, 2023). A clown has excellent skills for capturing and interpreting subtle signals 141 from people and their environments, allowing them to adapt their proposals and share the other 142 person's experience of reality. They also have an outstanding potential to understand and respond to 143 the emotional states of others, acting by focusing on the present and integrating elements provided by 144 their artistic tools to enhance participant engagement (Roberts et al., 2024). 145The hospital clown is clearly a supportive figure (Santos et al., 2021) the absence of verbal language, always respecting reality and individuality but using their creativity 174 to extend a patient's expression. 175The clown is an interlocutor who naturally experiences all facets of being human. This is, finally, the 176 essence of the clown: their poetic presence and actions transform the place and channel the emotional 177 circumstances of extreme moments (Santarpia et al., 2023). Poetics also brings psychological 178 comfort. Being a clown for patients experiencing such grave circumstances does not consist of 179 dressing up and wearing a red rubber nose: a clown is a human being who sublimates pain with art 180 and humanity. 181