title: Experiences and Expressions of Spirituality at the End of Life in the Intensive Care Unit.
abstract: The austere setting of the intensive care unit (ICU) can suppress expressions of spirituality.
  
  
  
  To describe how family members and clinicians experience and express spirituality during the dying process in a 21-bed medical-surgical ICU.
  
  
  
  Reflecting the care of 70 dying patients, we conducted 208 semistructured qualitative interviews with 76 family members and 150 clinicians participating in the Three Wishes Project. Interviews were recorded and transcribed verbatim. Data were analyzed by three investigators using qualitative interpretive description.
  
  
  
  Participants characterize dying as a spiritual event. Spirituality is an integral part of the life narrative of the patient before, during, and after death. Experiences and expressions of spirituality for patients, families, and clinicians during end-of-life care in the ICU are supported by eliciting and implementing wishes in several ways. Eliciting wishes stimulates conversations for people of diverse spiritual orientations to respond to death in personally meaningful ways that facilitate continuity and closure, and ease emotional trauma. Soliciting wishes identifies positive aspirations, which provide comfort in the face of death. The act of soliciting wishes brings clinician humanity to the fore. Wishing makes individual spiritual preferences and practices more accessible. Wishes may be grounded in spiritual goals, such as peace, comfort, connections, and tributes; they may seek a spiritually enhanced environment or represent specific spiritual interventions.
  
  
  
  Family members and clinicians consider spirituality an important dimension of end-of-life care. The Three Wishes Project invites and supports the expression of myriad forms of spirituality during the dying process in the ICU.
authors.affiliation: 1 Department of Clinical Epidemiology and Biostatistics.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Swinton
authors.affiliation: 1 Department of Clinical Epidemiology and Biostatistics.|2 Centre for Health Economics and Policy Analysis, and.
authors.forename: Mita
authors.initials: M
authors.lastname: Giacomini
authors.affiliation: 3 Department of Spiritual Care.
authors.forename: Feli
authors.initials: F
authors.lastname: Toledo
authors.affiliation: 3 Department of Spiritual Care.
authors.forename: Trudy
authors.initials: T
authors.lastname: Rose
authors.affiliation: 3 Department of Spiritual Care.
authors.forename: Tracy
authors.initials: T
authors.lastname: Hand-Breckenridge
authors.affiliation: 4 Family Medicine and Palliative Care, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.|5 Department of Medicine, and.
authors.forename: Anne
authors.initials: A
authors.lastname: Boyle
authors.affiliation: 4 Family Medicine and Palliative Care, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.|5 Department of Medicine, and.
authors.forename: Anne
authors.initials: A
authors.lastname: Woods
authors.affiliation: 1 Department of Clinical Epidemiology and Biostatistics.|6 Department of Critical Care, St. Joseph's Healthcare, Hamilton, Ontario, Canada; and.
authors.forename: France
authors.initials: F
authors.lastname: Clarke
authors.affiliation: 1 Department of Clinical Epidemiology and Biostatistics.
authors.forename: Melissa
authors.initials: M
authors.lastname: Shears
authors.affiliation: 7 Department of Emergency Medicine, North Cypress Medical Center, Cypress, Texas.
authors.forename: Robert
authors.initials: R
authors.lastname: Sheppard
authors.affiliation: 1 Department of Clinical Epidemiology and Biostatistics.|4 Family Medicine and Palliative Care, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.|5 Department of Medicine, and.|6 Department of Critical Care, St. Joseph's Healthcare, Hamilton, Ontario, Canada; and.
authors.forename: Deborah
authors.initials: D
authors.lastname: Cook
mesh_terms: D000368:Aged; D001293:Attitude to Death; D003142:Communication; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007407:Interviews as Topic; D008297:Male; D029181:Spirituality; D013727:Terminal Care
keywords: death; end of life; intensive care unit; palliative care; spirituality