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Initiating and integrating a personalized end of life care project in a community hospital intensive care unit: a mixed-method study of clinician and key stakeholder perspectives
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  • Eugenia Yeung,
  • Laurie Sadowski,
  • Kelsea Levesque,
  • Mercedes Camargo,
  • Allen Vo,
  • Elayn Young,
  • Erick Duan,
  • Jennifer Tsang,
  • Deborah Cook,
  • Benjamin Tam
Eugenia Yeung
University of Ottawa Faculty of Medicine
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Laurie Sadowski
Niagara Health System
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Kelsea Levesque
Niagara Health System
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Mercedes Camargo
Niagara Health System
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Allen Vo
Niagara Health System
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Elayn Young
Niagara Health System
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Erick Duan
Niagara Health System
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Jennifer Tsang
Niagara Health System
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Deborah Cook
McMaster University
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Benjamin Tam
Niagara Health System
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Abstract

Rationale The end of life (EOL) experience in the intensive care unit (ICU) can be psychologically distressing. The 3 Wishes Project (3WP) personalizes the EOL experience by carrying out wishes for dying patients and their families. While the 3WP has been integrated in academic, tertiary care ICUs, implementing this project in a community ICU has yet to be described. Objectives To examine facilitators of, and barriers to, implementing the 3WP in a community ICU from the clinician and key-stakeholder perspective. Methods This mixed-method study evaluated the implementation of the 3WP in a 20-bed community ICU in Southern Ontario, Canada. Patients were considered for the 3WP if they had a high likelihood of imminent death or planned withdrawal of life-sustaining therapy. Quantitative data include patient demographic data and wishes implemented. Following the qualitative descriptive approach, semi-structured interviews were conducted with purposively sampled clinicians and key-stakeholders. Data from transcribed interviews were analyzed in triplicate through qualitative content analysis. Results During the 10-month period, 66 of 67 wishes were completed, with a median of 4.5 wishes per patient-family dyad. Interviews with 12 participants indicated that the 3WP personalized and enriched the EOL experience for patients, families and clinicians. Interviewees indicated higher intensity education strategies were needed to enable spread as the project grew. Clinicians described many physical resources for the project but required more non-clinical project support for orientation, continuing education and data collection. Instead, these roles were completed by clinicians with saturated work capacity which may have inhibited the spread of the project. Conclusions In this community hospital, ICU clinicians and key stakeholders reported the 3WP improved EOL care for patients, families, and clinicians. Project implementation in a community ICU requires investigators take into account project characteristics and adapt the intervention to the community hospital context.

Peer review status:ACCEPTED

04 Oct 2020Submitted to Journal of Evaluation in Clinical Practice
05 Oct 2020Submission Checks Completed
05 Oct 2020Assigned to Editor
06 Oct 2020Reviewer(s) Assigned
12 Nov 2020Review(s) Completed, Editorial Evaluation Pending
12 Nov 2020Editorial Decision: Revise Minor
08 Dec 20201st Revision Received
14 Dec 2020Submission Checks Completed
14 Dec 2020Assigned to Editor
14 Dec 2020Review(s) Completed, Editorial Evaluation Pending
14 Dec 2020Editorial Decision: Revise Minor
04 Jan 20212nd Revision Received
04 Jan 2021Submission Checks Completed
04 Jan 2021Assigned to Editor
04 Jan 2021Review(s) Completed, Editorial Evaluation Pending
04 Jan 2021Editorial Decision: Accept