3 Wishes Without Borders: Enhancing End of Life Care for Hospitalized Patients

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Julie Reid
France Clarke
Neala Hoad
Rajendar Hanmiah
Daniel Brandt-Vegas
Zahira Khalid
Mark Soth
Feli Toledo
Lily Waugh
Leslie Brooks
Jason Cheung
Anne Boyle
Anne Woods
Kathleen Willison
Jessica Huynh
Deborah Cook

end of life, compassionate care, empathy, patient-centered care, palliative care

Abstract

Background
The 3 Wishes Project (3WP) was developed at St. Joseph’s Healthcare Hamilton to humanize the dying process by engaging patients and families in last wishes. Our objective was to pilot the 3WP on medical wards to gauge interest in expanding outside the intensive care unit (ICU) where it began.
Methods
We enrolled medical patients who had a high probability of dying during their admission, eliciting, implementing, and documenting terminal wishes. We analyzed data descriptively.
Results
From January 2017 to March 2020, we enrolled 23 patients and elicited 117 wishes (mean five wishes/patient). Direct engagement in the wish process was possible for 57% of patients. Common wish categories were: facilitating connections, family care, and humanizing the environment. The mean cost/patient was $16; 85% of wishes incurred no cost to the program.
Conclusions
The initial patients garnered sufficient interest to warrant further expansion. The 3WP was affordable and characterized by increased patient engagement.


Résumé
Contexte
Le 3 Wishes Project (3WP) a été mis sur pied au Centre de soins de santé StJoseph de Hamilton
pour humaniser la fin de vie en faisant participer les patients et leur famille aux dernières volontés. Notre étude visait à tester le 3WP dans des unités de soins médicaux pour évaluer l’intérêt à étendre ce projet en dehors de l’unité des soins intensifs (USI), là où il a vu le jour.


Méthodologie
Nous avons recruté des patients en milieu médical chez qui la probabilité de mourir au cours de leur hospitalisation était élevée et avons recueilli, exécuté et documenté des dernières volontés. Nous avons analysé les données d’un point de vue descriptif.


Résultats
Du mois de janvier 2017 au mois de mars 2020, nous avons recruté 23 patients et recueilli 117 volontés (moyenne de cinq volontés par patient). Une participation directe au processus des volontés a été possible chez 57 % des patients. Les catégories de volontés les plus courantes sont : facilitation des liens, soins à la famille et humanisation de l’environnement. Le coût moyen par patient est de 16 $; 85 % des volontés n’ont entraîné aucun coût pour le programme.


Conclusions
Les premiers patients ont suscité suffisamment d’intérêt pour qu’il soit justifié d’étendre davantage le programme. Le 3WP est abordable et caractérisé par une participation accrue des patients.

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References

1. Blinderman C. Palliative care, public health and justice: Setting priorities in
resource poor countries. Dev World Bioeth. 2009 Dec;9(3):15–110. http:// dx.doi.org/10.1111/j.1471-8847.2009.00264.x
2. Canadian Hospice Palliative Care Association. What Canadians say: The way
forward survey report. Ottawa, ON: Harris/Decima; 2013.
3. Statistics Canada. Table 13-10-0715-01—Deaths, by place of death (hospital or
non-hospital), Canada, provinces and territories, annual (database) [Internet]. [cited 2020 Nov 04]. Available from: https://www150.statcan.gc.ca/t1/tbl1
/en/tv.action?pid=1310071501&pickMembers%5B0%5D=1.1& cubeTimeFrame.startYear=2018&cubeTimeFrame. endYear=2018&referencePeriods=20180101%2C20180101
4. Saunders C. Introduction: History and challenge. In: Saunders C, Sykes N, editors. The management of terminal malignant disease. London: Hodder and Stoughton; 1993. p. 1–14.
5. Woodruff R. Palliative medicine: Symptomatic and supportive care for patients with advanced cancer and AIDS. 2nd ed. Melbourne, Australia:
Asperula; 1996.
6. Virdun C, Luckett T, Lorenz K, et al. Dying in the hospital setting: A meta-
synthesis identifying the elements of end-of-life care that patients and their families describe as being important. Palliat Med. 2017 Jul;31(7):587–601. http://dx.doi.org/10.1177/026921631667354
7. Cook DJ, Swinton M, Toledo F, et al. Personalizing death in the ICU: The
three wishes project. Ann Intern Med. 2015;163(4):271–9. http://dx.doi.
org/10.7326/M15-0502
8. Vanstone M, Neville TH, Clarke FJ, et al. Compassionate end-of-life care: Mixed-methods multisite evaluation of the 3 wishes project. Ann Intern Med.
2020;172:1–11. http://dx.doi.org/10.7326/M19-2438
9. Centofanti J, Swinton M, Dionne J, et al. Resident reflections on end-of-
life education: A mixed methods study of the 3 wishes project. BMJ Open. 2016;6:e010626. http://dx.doi.org/10.1136/bmjopen-2015-010626
10. Vanstone M, Toledo F, Clarke F, et al. Narrative medicine and death in the ICU: Word clouds as a visual legacy. BMJ Support Palliat Care. 2016;0:1–8.
http://dx.doi.org/10.1136/bmjspcare-2016-001179
11. Lo B. Improving care near the end of life. Why is it so hard?
JAMA. 1995;274:1634–6. http://dx.doi.org/10.1001/jama.1995.03530200070042

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