The 3 Wishes Program Improves Families' Experience of Emotional and Spiritual Support at the End of Life
Thanh H Neville1, Zachary Taich2, Anne M Walling3,4
1Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA. tneville@mednet.ucla.edu.
Background:
The end-of-life (EOL) experience in the intensive care unit (ICU) is emotionally challenging, and there are opportunities for improvement. The 3 Wishes Program (3WP) promotes the dignity of dying patients and their families by eliciting and implementing wishes at the EOL.
Aim:
To assess whether the 3WP is associated with improved ratings of EOL care.
Program Description:
In the 3WP, clinicians elicit and fulfill simple wishes for dying patients and their families.
Setting:
2-hospital academic healthcare system.
Participants:
Dying patients in the ICU and their families.
Program Evaluation:
A modified Bereaved Family Survey (BFS), a validated tool for measuring EOL care quality, was completed by families of ICU decedents approximately 3 months after death. We compared patients whose care involved the 3WP to those who did not using three BFS-derived measures: Respectful Care and Communication (5 questions), Emotional and Spiritual Support (3 questions), and the BFS-Performance Measure (BFS-PM, a single-item global measure of care).
Results:
Of 314 completed surveys, 117 were for patients whose care included the 3WP. Bereaved families of 3WP patients rated the Emotional and Spiritual Support factor significantly higher (7.5 vs. 6.0, p = 0.003, adjusted p = 0.001) than those who did not receive the 3WP. The Respectful Care and Communication factor and BFS-PM were no different between groups.
Discussion:
The 3WP is a low-cost intervention that may be a feasible strategy for improving the EOL experience.
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