Project to answer last wishes spreads successfully

November 11, 2019

HAMILTON, ON (Nov. 11, 2019) - New research led by McMaster University researchers has found a program that honours dying patients by fulfilling end of life wishes can be powerful, affordable and sustainable in many settings.

Six years ago the initial Three Wishes Project began at St. Joseph's Healthcare Hamilton, when hospital staff asked patients or their families how they might honour the life and dignity of those dying in the intensive care unit. Staff would then help families by implementing these wishes.

Now a study with three additional hospital intensive care unit sites in Toronto, Vancouver and Los Angeles, California has proven the project is a success elsewhere. The research was published in the Annals of Internal Medicine today.

The wishes range from bringing personal items and pictures from home into the ICU and providing favourite music to offering spiritual support and connecting long lost family. There are visits by favourite pets, the co-creation of keepsake crafts and celebrations including weddings. Some families have continued cherished traditions such as watching the hockey game together while enjoying a favourite beverage, or having a "date night" with take-out food from a local restaurant.

"The wishes are usually simple reflecting preferences of the dying patient. Families find the acts of compassion comforting, which strengthens their relationship with the staff. The multidisciplinary health care staff members find this type of empathic care helps to make work meaningful," said senior author Dr. Deborah Cook.

Cook is a professor of the departments of medicine and of health research methods, evidence, and impact at McMaster University and a critical care physician at St. Joseph's Healthcare Hamilton.

The study involved a total of 730 patients and a total of 3,407 wishes at the four hospitals of St. Joseph's in Hamilton; St. Michael's Hospital in Toronto, Vancouver General Hospital in Vancouver and the Ronald Reagan UCLA Medical Center in Los Angeles.

The program was started by a variety of health care providers from physicians and nurses to chaplains and social workers. Each site started the program in slightly different ways. Staff became enthusiastic, and found ways to keep the program going after the research project officially ended.

First author Meredith Vanstone, an associate professor of family medicine at McMaster, said: "Family members consistently reported the project enhanced their experience of care, easing bereavement by encouraging conversations about wishes to redirect attention from the person's illness to his or her identity.

"We also found that as the program became more established, more frontline clinicians were comfortable initiating the Three Wishes Project independently."

One daughter is quoted in the study saying: "It changed the focus of a negative experience into a more positive experience towards the end. We were able to focus on who my dad was, versus what's happening to my dad."

The cost of the program is low - about $5 per wish - said study authors, because these activities are typically done while staff is at work, and clinicians report the time requirement as typically minimal. Each site had an initial investment for reusable materials and some items were donated. Most patients had more than three wishes completed, and more than three-quarters of the wishes cost nothing.

Said one hospital administrator quoted in the study: "Honestly, if I look at the value of this project against the investment of resources, it's hugely in favour of the value it brings. Not just from a staff perspective but from a patients and family centeredness perspective."

The study authors summarize, by saying the project "facilitates compassionate care by recognizing the inherent dignity of dying patients and encouraging connections among patients, clinicians and family members. Local adaptions encouraged each group to take ownership of the program to suit their interest, needs and resources. When championed by bedside clinicians, the Three Wishes Project is a transferrable, affordable, and sustainable program that can provide value at the end of life."

Primary funding for the research came from the Greenwall Foundation, with donations from philanthropists, ICU staff at St. Joseph's, the Canadian Institutes of Health Research and, in Los Angeles, from the California State University Institute for Palliative Care.
-end-
Editors: Pictures of Deborah Cook and Meredith Vanstone are attached.

For more information or to arrange an interview, please contact:

Veronica McGuire
Media Relations
Faculty of Health Sciences
McMaster University
vmcguir@mcmaster.ca
905-525-9140, ext. 22169

McMaster University

Related Intensive Care Unit Articles from Brightsurf:

Hospital COVID-19 risk lowest among intensive care staff
Contrary to expectations, the risk of COVID-19 infection among hospital staff at the height of the coronavirus pandemic was lowest among intensive care clinicians, reveals a study of one major UK medical centre, published in the journal Thorax.

Pregnant women with COVID-19 may more likely need intensive care and give birth early
Pregnant women seen in hospitals with covid-19 are less likely to show symptoms, and seem to be at increased risk of needing admission to an intensive care unit than non-pregnant women of similar age, finds a study published by The BMJ today.

Many children in intensive care may not be getting rehabilitation therapy, study shows
Adult patients in hospital intensive care units (ICUs) are often given rehabilitation therapy and urged to keep mobile from an early point in their hospital stays.

Demand for US hospital inpatient, intensive care unit beds for patients with COVID-19
The intensive care unit and inpatient bed needs for patients with coronavirus disease 2019 (COVID-19) in two cities in China are described and compared to estimate the peak number of intensive care unit beds needed in US cities if an outbreak equivalent to that in Wuhan occurs.

Cognitive impairment after intensive care linked to long-lasting inflammation
People who have been treated in intensive care commonly suffer from residual cognitive impairment, but the reason for this is unknown.

New guidelines for hepatic failure in the intensive care unit
For critical care specialists, hepatic failure poses complex challenges unlike those of other critical illnesses.

Hospital critical care resuscitation unit improves patients' chances of survival
Patients with acutely life-threatening health conditions who were treated in the innovative Critical Care Resuscitation Unit (CCRU) received faster treatment and had better health outcomes, including a 36 percent lower risk of dying than those who were transferred from a hospital's emergency department then evaluated and treated in a traditional intensive care unit, according to a recent study in the Journal of Emergency Medicine conducted by researchers at the University of Maryland School of Medicine.

Once scarce, neonatal intensive care proliferates
Is NICU care being driven by medical need or competition?

Emergency medicine: Department-based intensive care unit improves patient survival rates
A new Michigan Medicine study found that implementing a dedicated emergency medicine department-based intensive care unit improved patient survival rates and lowered inpatient intensive care unit (ICU) admissions.

Shorter rotations in intensive care units mitigate burnout among physicians
Shortening the length of rotations in a medical intensive care unit (MICU) from the traditional 14-consecutive day schedule to only seven days helps mitigate burnout among critical care physicians, according to a new Penn Medicine pilot study.

Read More: Intensive Care Unit News and Intensive Care Unit Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.