Compassionate End-of-Life Care in the ICU: Mixed-methods multi-site evaluation of the 3 Wishes Project
CCCF ePoster library. Clarke F. 11/13/19; 286410; EP128
France Clarke
France Clarke
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Abstract
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Background: The 3 Wishes Project is an end-of-life program which aims to honor the life and dignify the death of patients, creating positive memories for their families to attenuate suffering, while promoting humanistic interprofessional care.

Objective: To determine whether the 3 Wishes Project could be successfully implemented beyond the ICU in which it was created. Success was defined as demonstrating affordability, transferability, sustainability and value.

Methods: This study describes the results of mixed-methods formative program evaluation of the 3 Wishes Project, an end-of-life program which honors patients by eliciting and implementing wishes from patients, family members and clinicians. The 3 Wishes Project was implemented in ICUs at St Joseph’s Healthcare, Hamilton in Hamilton, Ontario; St. Michael’s Hospital in Toronto, Ontario; Ronald Reagan UCLA Medical Center in Los Angeles, California and Vancouver General Hospital in Vancouver, British Columbia. Data about patient characteristics and processes of care; the number, type and cost of each wish were collected. Semi-structured interviews and focus groups with family members, clinicians and managers were used to elicit information about experiences and influence of this program.

Results: We enrolled 730 patients and implemented 3407 wishes. Qualitative data were gathered from 74 family members, 72 clinicians and 20 managers. The 3 Wishes Project is an affordable program costing approximately $5 per wish, transferable to ICUs in different healthcare systems. Sustainable beyond the duration of research funding, it provides value by celebrating lives, supporting families, increasing clinician agency, and extending existing high quality end-of-life care in different settings.

Conclusion: 3WP facilitates compassionate care by encouraging connections between patients, clinicians and family members for the purpose of recognizing the inherent dignity of dying patients.  While some commonalities exist across centers, local adaptations encouraged “owning” the program in a way that suited their interests, capabilities and resources. 3WP is a transferrable, affordable, and sustainable intervention that can provide value when local clinicians seek to champion and sustain implementation.
 

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