To improve the quality of the dying experience for patients and their families

Overall Goal of The 3 Wishes Project

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 medical-

surgical 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 Criteria1) 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 Criteria1) Serious psychological, psychiatric or language

issue precluding engagement

2) Patient admitted to ICU for <12 hours

3) Patient or family declines

Mixed-Methods Design

QualitativeData

Family & Clinician

Interviews

Letters & Field Notes

Wish Interpretation

QuantitativeData

PatientDemographics

& Life Supports

Family &Clinician

Demographics

FamilyQEOL-10Survey

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

DignifyingThe

Patient

Giving VoiceTo The Family

Calling ForthClinician

Compassion

Humanizingthe

Environment

Tributes

Rituals Paying ItForward

Connections

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 nickname or preferred name

Word cloud Skype reunion Renewal of wedding vows

Family & friend donations to 3 Wishes

Personal keepsakes in the room

Tea party Pet visitation Wedding Contribution to charity important to the patient

Flowers for the room

Birthday cake Hosting final supper

Firework display

Organ donation

A special collaboration

Spiritual CarePalliative CareCritical Care