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