Improving End-of Life Care: Implementation and Evaluation of the 3 Wishes Project in an American Health System (GP771)

• Published in: Journal of pain and symptom management Vol. 60; no. 1; pp. 287 - 288
• Main Authors: Neville, Thanh, Phung, Peter, Bear, Danielle, Agarwal, Neha, Xu, Xueqing, Kao, Yuhan, Hjelmhaug, Kristen, Hainje, Jessica, Swinton, Marilyn, Jakel, Patricia, Bell, Allegra, Ewer, Rayna, McCann, Kelly, Karlin, Daniel, Roque, Leah, Sanaee, Natalie, Do, Jennifer, Donovan, Melanie, Hardin-Wike, Brenda, Shachat, Leora, Wang, Tisha, Sheth, Corinne, Cook, Deborah
• Format: Journal Article
• Language: English
• Published: Madison Elsevier Inc 01.07.2020; Elsevier Limited
• Subjects: Content analysis; Death & dying; Empathy; End of life decisions; Focus groups; Hospitals; Intensive care; Interviews; Kindness; Leadership; Memories; Mirroring; Nurses; Oncology; Patient-centered care; Patients; Qualitative research; Teamwork
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2020.04.198

Objectives Describe the objectives of the 3 Wishes Project Describe the logistics of the 3WP how it can be implemented to a different institution Describe some of the perceived effects of the 3WP has had on families and clinicians. Importance. Empathy, dignity, and goal-concordance are cornerstones of high quality end-of-life (EOL) care. Initiated in Canada, the 3 Wishes Project (3WP) is a program where clinicians elicit and implement final wishes for patients dying in intensive care units (ICU) and their families in an effort to improve the EOL experience. Objective. To implement the 3WP in an American health system and evaluate its value from the perspective of families, clinicians, and hospital leadership. Methods. When a patient's probability of dying is greater than 95% or if the patient will be transitioned to hospice, patients and families are invited to participate in the 3WP. Wishes are elicited, implemented, and documented.We conducted 39 semi-structuredinterviews with families of 3WP patients, 5 focus groups with 25 nurses and 5 physicians, and 5 semi-structured interviews with hospital leadership to evaluate the effectiveness of the initiative. All interviews and focus groups were digitally recorded, transcribed, and analyzed using content analysis. Results. During a 22-month period, the 3WP was initiated in one ICU then expanded to 4 additional units (3 ICU's, 1 solid oncology ward) in two hospitals of a large academic health system. We have fulfilled 1062 wishes for 292 patients at an average cost of $30.35/patient. Qualitative analysis revealed that families felt the 3WP provided a personalized way to say goodbye, amechanism to create memories and keepsakes, and a sense that they were not alone. Focus groups with clinicians showed how the 3WP facilitated meaningful EOL care, fostered teamwork, and mitigated the stress of caring for dying patients. By encouraging explicit acts of kindness, the 3WP was perceived by hospital leadership as of high value, mirroring the institutional mission of patient-centered care. Conclusion/Impact. The 3WP is a transferrable and affordable intervention that is meaningful from all stakeholders' perspectives.