D Cook, M Swinton, F Toledo, F Clarke, T Rose, T Hand-Breckenridge, A Boyle, A Woods, N Zytaruk, D Heels-Ansdell, R Sheppard
Background: Dying in the complex, efficiency-driven environment of the intensive care unit (ICU) can have profound, long-lasting consequences for all persons attendant to that death.
Objective: To bring peace to the final days of a patient's life and ease the grieving process.
Design: Mixed-methods study in a 21-bed medical-surgical ICU.
Participants: Dying critically ill patients, their families and 3 of their clinicians.
Interventions: From the patient, family member or bedside clinicians we sensitively elicited, then implemented a set of 3 wishes to honour the dying patient.
Measurements: Quantitative data included demographic and processes of care variables. Wishes were interpreted and classified in several dimensions (category, realization, origin, timing and cost). Semi-structured interviews of family members and clinicians were transcribed verbatim and analyzed with qualitative description.
Results: Participants included 40 decedents, 49 family members, and 120 clinicians. 158 wishes were classified in 5 categories: humanizing the environment, tributes, family reconnections, observances, and 'paying it forward'. The central theme from 169 interviews was how the 3 Wishes Project personalized the dying process. For patients, eliciting and customizing the wishes honoured them by celebrating their life and dignifying their death. For families, it created positive memories and individualized end-of-life care for their loved one. For clinicians, it promoted interprofessional care and exemplified humanism in practice.
Conclusions: The 3 Wishes Project facilitated personalization of the dying process in the ICU through the explicit integration of palliative care and spiritual care into critical care practice.