Enhancing end of life care on general internal medical wards: the 3 Wishes Project

Julie C Reid; Brittany Dennis; Neala Hoad; France Clarke; Rajendar Hanmiah; Daniel Brandt Vegas; Anne Boyle; Feli Toledo; Jill C Rudkowski; Mark Soth; Diane Heels-Ansdell; Andrew Cheung; Kathleen Willison; Thanh H Neville; Jason Cheung; Anne Woods; Deborah Cook

doi:10.1186/s12904-023-01133-4

Enhancing end of life care on general internal medical wards: the 3 Wishes Project

BMC Palliat Care. 2023 Feb 14;22(1):11. doi: 10.1186/s12904-023-01133-4.

Authors

Julie C Reid¹, Brittany Dennis², Neala Hoad³, France Clarke³, Rajendar Hanmiah^{2

4}, Daniel Brandt Vegas^{2

4}, Anne Boyle^{4

5}, Feli Toledo⁶, Jill C Rudkowski^{2

3

4}, Mark Soth^{2

3

4}, Diane Heels-Ansdell⁷, Andrew Cheung^{2

4}, Kathleen Willison^{4

5

8}, Thanh H Neville⁹, Jason Cheung^{2

4}, Anne Woods^{4

5}, Deborah Cook^{7

2

3

4}

Affiliations

¹ Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON, L8S 4K1, Canada. reidj7@mcmaster.ca.
² Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON, L8S 4K1, Canada.
³ Department of Critical Care, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
⁴ Department of Medicine, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
⁵ Division of Palliative Care, Department of Family Medicine, Faculty of Health Sciences, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 6th Floor, Hamilton, ON, L8P 1H6, Canada.
⁶ Department of Spiritual Care, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
⁷ Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON, L8S 4K1, Canada.
⁸ School of Nursing, Faculty of Health Sciences, Health Sciences Centre, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
⁹ Department of Medicine, Division of Pulmonary & Critical Care, University of California Los Angeles, Los Angeles, CA, 90095, USA.

Abstract

Background: Initially developed in the intensive care unit (ICU) at St. Joseph's Healthcare Hamilton (SJHH) the 3 Wishes Project (3WP) provides personalized, compassionate care to dying patients and their families. The objective of this study was to develop and evaluate 3WP expansion strategies for patients cared for on General Internal Medicine (GIM) wards in our hospital.

Methods: From January 2020-November 2021, we developed a phased, multicomponent approach for program expansion. We enrolled patients on the GIM wards who had a high probability of dying in hospital, then elicited, implemented, and documented wishes for them or their families. Data were analyzed descriptively.

Results: From March 2020 to November 2020, we implemented staff education and engagement activities, created an Expansion Coordinator position, held strategic consultations, and offered enabling resources. From March 2020 to November 2021, we enrolled 62 patients and elicited 281 wishes (median [1^st, 3^rd quartiles] 4 [4, 5] wishes/patient). The most common wish categories were personalizing the environment (67 wishes, 24%), rituals and spiritual support (42 wishes, 15%), and facilitating connections (39 wishes, 14%). The median [1^st, 3^rd] cost/patient was $0 [0, $10.00] (range $0 to $86); 91% of wishes incurred no cost to the program.

Conclusions: The formal expansion of the 3WP on GIM wards has been successful despite COVID-19 pandemic disruptions. While there is still work ahead, these data suggest that implementing the 3WP on the GIM wards is feasible and affordable. Increased engagement of the clinical team during the pandemic suggests that it is positively received.

Keywords: Acute care; Compassionate care; Empathy; End-of-life; Palliative care; Patient-centered care.

MeSH terms

COVID-19*
Hospice Care*
Humans
Intensive Care Units
Pandemics
Terminal Care*

Abstract

MeSH terms

Grants and funding