Transcript 3 Wishes Project Summary Slides 16June2016

Overall Goal of
The 3 Wishes Project
To improve the quality of the dying
experience for patients and their
families
3 Specific Objectives
• For patients, to dignify their death and
celebrate their life
• For family members, to humanize the dying
process and create positive memories
• For ICU clinicians, to foster patient and
family-centered care and inspire a deeper
sense of our vocation
Rationale
• this individualized approach to end of life
care acknowledges that the dying person
and their family members are uniquely
human
Design
• mixed-methods demonstration project
Setting
• 21-bed closed university-affiliated medicalsurgical ICU
Premise of the 3 Wishes
• Bringing a set of 3 wishes to fulfillment in
the hope of bringing peace to the final
days or hours of a patient’s life
Wishes may be those of
– the patient
– their family members
– ICU clinicians
– 3 Wishes team
Inclusion Criteria
1) Patients with >95% probability of dying during
the ICU stay
2) Decision made to withdraw or withhold
advanced life support in anticipation of death
Exclusion Criteria
1) Serious psychological, psychiatric or language
issue precluding engagement
2) Patient admitted to ICU for <12 hours
3) Patient or family declines
Mixed-Methods Design
Qualitative
Data
Family &
Clinician
Interviews
Letters
& Field
Notes
Quantitative
Data
Wish
Interpretation
Patient
Demographics
&
Life Supports
Family &
Clinician
Demographics
Family
QEOL-10
Survey
What is a Wish?
A wish is a Process…. And a Product
• A means to recognize the patient
• An example of dignity-conserving care
• A tangible expression of empathy
• An opportunity for reflection
• A vehicle for inter-professional care
• A manifestation of hope
• A therapeutic connection
• A transitional activity
• An expression of spirituality
• A secular prayer
Qualitative Results:
Personalizing Dying in the ICU
Wish Categories
Humanizing
the
Environment
Tributes
Connections
Rituals
Paying It
Forward
Favourite
music
Final toast
Finding a lost
relative
Movie night
Hospital
volunteer
position
Using patient’s Word cloud
nickname or
preferred name
Skype reunion
Renewal of
wedding vows
Family & friend
donations to 3
Wishes
Personal
keepsakes in
the room
Pet visitation
Wedding
Contribution to
charity
important to
the patient
Hosting final
supper
Firework
display
Organ
donation
Tea party
Flowers for the Birthday cake
room
A special
collaboration
Spiritual Care
Palliative Care
Critical Care