Project allows ICU patients, families to personalize dying process

Last wishes of ICU patients, from bagpipe music to charitable donations, were fulfilled by researchers, who found positive impact on patients, families, and clinicians.

A mixed-methods study showed that implementing the wishes of dying ICU patients and their families individualized care and brought some comfort.

Through the 3 Wishes Project, patients, families, and clinicians aimed to honor dying patients by generating a set of wishes and implementing them both before and after death. In addition to 40 patients, participants included at least 1 family member per patient and 3 clinicians per patient. Findings of the study, which was conducted on a 21-bed medical and surgical ICU, were published online on July 14 by Annals of Internal Medicine.

The 159 wishes fell into 5 categories: humanizing the environment, tributes, family reconnections, observances, and “paying it forward.” Respective examples included playing Scottish bagpipe music at the time of death; holding a tea party at the patient's bedside; locating an estranged relative; renewing wedding vows at the bedside; and the project making a donation to a charity significant to the patient. Wishes were implemented before (82 wishes, 51.6%) and after (77 wishes, 48.4%) death and ranged in cost from $0 to about $200 per patient.

The researchers noted that a major limitation of the study was that impaired consciousness in 33 of 40 dying patients made it difficult to ascertain their viewpoints. Therefore, they focused on the impact of the project from the perspective of the patients' families and clinicians.

Researchers compiled quantitative data from demographics, processes of care, and scores on the Quality of End-of-Life Care—10 instrument, which were high. They also conducted 160 interviews of family members and clinicians, transcribed them verbatim, and analyzed them through qualitative description, finding a central theme that the intervention personalized dying in the ICU. Clinicians reported a sense of collective purpose for bedside staff.

“For patients, eliciting and customizing the wishes honored them by celebrating their lives and dignifying their deaths,” the study authors wrote. “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.” Researchers noted that results may differ with a more diverse patient and staff population. The study did not provide a total cost for the project, which was funded by the Hamilton Academy of Health Science Research Organization and Canadian Intensive Care Foundation.

An accompanying editorialist noted that some might doubt the design, reproducibility, and sustainability of the study, but that he did not, calling it a “proof of concept for a pragmatic intervention” and encouraging physicians to test the concept in their own practices.