title: Personalizing death in the intensive care unit: the 3 Wishes Project: a mixed-methods study.
abstract: BACKGROUND
  Dying 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.
  
  
  OBJECTIVE
  To bring peace to the final days of a patient's life and to ease the grieving process.
  
  
  METHODS
  Mixed-methods study.
  
  
  METHODS
  21-bed medical-surgical intensive care unit.
  
  
  METHODS
  Dying patients and their families and clinicians.
  
  
  METHODS
  To 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.
  
  
  METHODS
  Quantitative 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.
  
  
  RESULTS
  Participants 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.
  
  
  CONCLUSIONS
  Impaired consciousness limited understanding of patients' viewpoints.
  
  
  CONCLUSIONS
  The 3 Wishes Project facilitated personalization of the dying process through explicit integration of palliative and spiritual care into critical care practice.
  
  
  BACKGROUND
  Hamilton Academy of Health Science Research Organization, Canadian Intensive Care Foundation.
authors.forename: Deborah
authors.initials: D
authors.lastname: Cook
authors.forename: Marilyn
authors.initials: M
authors.lastname: Swinton
authors.forename: Feli
authors.initials: F
authors.lastname: Toledo
authors.forename: France
authors.initials: F
authors.lastname: Clarke
authors.forename: Trudy
authors.initials: T
authors.lastname: Rose
authors.forename: Tracey
authors.initials: T
authors.lastname: Hand-Breckenridge
authors.forename: Anne
authors.initials: A
authors.lastname: Boyle
authors.forename: Anne
authors.initials: A
authors.lastname: Woods
authors.forename: Nicole
authors.initials: N
authors.lastname: Zytaruk
authors.forename: Diane
authors.initials: D
authors.lastname: Heels-Ansdell
authors.forename: Robert
authors.initials: R
authors.lastname: Sheppard
mesh_terms: D000368:Aged; D002170:Canada; D004645:Empathy; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D010166:Palliative Care / Q000523:psychology*; D010358:Patient Participation; D010361:Patients / Q000523:psychology; D057285:Precision Medicine / Q000523:psychology*; D011368:Professional-Family Relations; D012297:Right to Die; D029181:Spirituality; D013727:Terminal Care / Q000523:psychology