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.
Introduction and Objectives
Advances in health care have changed the fundamental human experience of death. Though dying at home has been consistently described as the preferred location for death, more Canadians now die in an intensive care unit (ICU) than before.1,2 This presents an environment replete with technology within an institutional setting that propagates the medicalization of death as the backdrop for end of life (EOL) care. This setting can obscure humanity in the dying process for patients, and perpetuate grief, anxiety, depression and post-traumatic stress disorder in bereaved family members. 1,3Moreover, clinicians experience disengagement and moral distress when death is dehumanized.4–8
The 3 Wishes Project (3WP), an innovative project implemented in academic ICUs in both Canada and the United States, aims to improve EOL care by personalizing and humanizing the EOL experience through the elicitation and implementation of wishes for patients, family members and/or clinicians. It was created for the purpose of strengthening the relationships among patients, family members, and clinicians that are crucial for empathic EOL care.9 The wishes implemented are classified into 11 categories: facilitating connections with families/ friends/ pets, celebrations involving food/beverages, humanizing the ICU room, humanizing the patient, music, family care, religious rituals & spiritual ceremonies, preparations and final arrangements, keepsakes and post mortem tributes, organ & tissue donation and paying it forward for the 3WP.10 A mixed-method, multi-site study conducted in an academic, tertiary level ICU demonstrated that the 3WP helped personalize the dying process through explicit integration of palliative and spiritual care into critical care practice.10 Additionally, a recent study conducted by Vanstone et. al concluded that the 3WP is an affordable, transferrable and sustainable clinical project that facilitates collaborative care that honors a person’s identity and preferences.9
Personalizing EOL care can take on various forms and as such, the 3WP may have unique features in different environments.9,11 The adaptable nature of this EOL project may facilitate spread to community ICUs, which may not have a robustly developed EOL infrastructure.12,13 Clinicians responsible for EOL care in the ICU are instrumental to 3WP implementation; therefore in order to introduce the 3WP in community ICUs and facilitate its uptake, this mixed-methods study describes the clinician and key stakeholder perspective of a 3WP implementation in a large, community ICU.
Methods