• Deborah Cook, Marilyn Swinton, Feli Toledo, France Clarke, Trudy Rose, Tracey Hand-Breckenridge, Anne Boyle, Anne Woods, Nicole Zytaruk, Diane Heels-Ansdell, and Robert Sheppard.
• Ann. Intern. Med. 2015 Aug 18; 163 (4): 271-9.

BackgroundDying in the complex, efficiency-driven environment of the intensive care unit can be dehumanizing for the patient and have profound, long-lasting consequences for all persons attendant to that death.ObjectiveTo bring peace to the final days of a patient's life and to ease the grieving process.DesignMixed-methods study.Setting21-bed medical-surgical intensive care unit.ParticipantsDying patients and their families and clinicians.InterventionTo honor each patient, a set of wishes was generated by patients, family members, or clinicians. The wishes were implemented before or after death by patients, families, clinicians (6 of whom were project team members), or the project team.MeasurementsQuantitative data included demographic characteristics, processes of care, and scores on the Quality of End-of-Life Care-10 instrument. Semistructured interviews of family members and clinicians were transcribed verbatim, and qualitative description was used to analyze them.ResultsParticipants included 40 decedents, at least 1 family member per patient, and 3 clinicians per patient. The 159 wishes were implemented and classified into 5 categories: humanizing the environment, tributes, family reconnections, observances, and "paying it forward." Scores on the Quality of End-of-Life Care-10 instrument were high. The central theme from 160 interviews of 170 persons was how the 3 Wishes Project personalized the dying process. For patients, eliciting and customizing the wishes honored them by celebrating their lives and dignifying their deaths. For families, it created positive memories and individualized end-of-life care for their loved ones. For clinicians, it promoted interprofessional care and humanism in practice.LimitationImpaired consciousness limited understanding of patients' viewpoints.ConclusionThe 3 Wishes Project facilitated personalization of the dying process through explicit integration of palliative and spiritual care into critical care practice.Primary Funding SourceHamilton Academy of Health Science Research Organization, Canadian Intensive Care Foundation.

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