Spirituality and End-of-life Wishes in the ICU: A Multicenter Quantitative Analysis of the 3 Wishes Project
CCCF ePoster library. Piticaru J. 11/11/19; 286409; EP27
Joshua Piticaru
Joshua Piticaru
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Abstract
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Introduction

Death can be experienced as a highly spiritual event by many patients, families and healthcare workers, who often struggle to cope with the acuity and devastation of critical illness. Spirituality, a belief in something beyond oneself, is a human experience that may facilitate coping for those who bear witness to the transition from life-support interventions to end-of-life care. The 3 Wishes Project (3WP) is a multicenter, prospective study in which clinicians elicit and implement patient-centered wishes for dying critically ill patients in the ICU. Wishes can be articulated by patients, families, or members of the healthcare team.

Objectives

The purpose of this analysis was to characterize wishes of a spiritual nature that occurred at the end-of-life in the ICU as captured in the 3WP.

Methods

We conducted a quantitative analysis of the 3WP database to identify the proportion of patients who were spiritual and the prevalence of spiritual wishes at the end of life. We identified patients as “spiritual” if they had any listed spiritual beliefs (including “spiritual”), and “non-spiritual” if they self-reported as “agnostic” or “none indicated”. Patients without documented spiritual preferences were classified as “unknown” and excluded from analysis.

Results

Overall, 873 patients were included in the database over a six-year study period (November 2012 to May 2019) across six North American sites. A majority (60.7%) of patients were identified as spiritual (530/873), 23.6% as non-spiritual (206/873), and 15.7% as unknown (137/873). A minority (13.3%) of total wishes in the 3WP database were classified as spiritual (522/3921). However, for 35.6% of all dying patients, there was at least one spiritual wish at the end-of-life. During the dying process, spiritual patients, compared to others, more frequently had spiritual wishes elicited and implemented (56.5% vs 19.0%, p<0.0001), as well as spiritual care consultation (85.6% vs 46.4%, p=0.01). Spiritual wishes were most commonly requested by families for both spiritual and non-spiritual patients (89.3% vs 79.5%, p=0.02), followed by patients themselves (4.5% vs 9.6%, p>0.05). Prayer was the most commonly elicited wish (19.9%), followed by a ceremony or ritual (16.5%), and request for spiritual support at the bedside (7.9%).

Conclusions

In a diverse patient population across multiple North American institutions, patients and their families frequently invoke spirituality during the dying process. In the context of our increasingly pluralistic society, the 3 Wishes Program fostered an environment that empowers patients and families – whether identified as spiritual or not – to address this important

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