THE 3 WISHES PROJECT: A FEASIBLE INTERVENTION TO IMPROVE END OF LIFE CARE IN THE ICU AT UCLA

SESSION TITLE: Palliative Care and End-of-Life Issues SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: The end of life in the Medical Intensive Care Unit (MICU) can be a distressing experience for patients and family members. Families must cope with the realization that their loved one has an incurable malady in an often chaotic and impersonal environment. This project aims to personalize and humanize the dying experience by eliciting and implementing a patient’s final 3 wishes. Mirrored after Cook et. al’s “The 3 Wishes Project” in Canada, we aim to bring the intervention to a busy American tertiary care medical ICU. This intervention seeks to redefine the dying process by refocusing patients’ and family members’ attention towards honoring one’s life and celebrating what remains. METHODS: This study is conducted in a 24-bed academic tertiary care MICU. A research team of palliative and critical care physicians, nurses, and residents met regularly to discuss intervention implementation. A call schedule was created to ensure the availability of a team member for the facilitation of 3 Wishes. Once the primary ICU team determines that a patient’s probability of dying in the MICU was greater than 95% or there is a decision to withdraw life support expecting death, the research team is notified and invites the patient/families to participate in 3 wishes. Wishes are elicited, implemented, and documented. Shortly after a patient’s death, sympathy cards are mailed. Family members will be invited for interviews 1-6 months after their loved one’s death to discuss how this project may have impacted their loved one, the grieving process, and their relationship with the clinical team. RESULTS: In a two month period, twenty patients have been enrolled. The average age was 61 and 45% were female. For these 20 patients, the research team elicited 67 wishes, and implemented 64 wishes (95%). Examples of wishes included: terminal extubation outside the ICU, decorating the room, flowers, pet therapy, and playing the patient’s favorite music. The categories of wishes were: humanizing the environment (18), providing keepsakes and tributes (12), music (8), rituals and spiritual support (5), food and beverages (5), humanizing the patient (5), family care (4), facilitating connections with friends/families (4), and other miscellaneous items (3). The cost of wishes ranged from $2 to $175, and averaged $35 per patient. The research team sent sympathy cards to 20 families, and have interviewed 1 family to date. CONCLUSIONS: It is feasible and inexpensive to implement the 3 Wishes Project in a busy American tertiary care ICU. CLINICAL IMPLICATIONS: Although care providers in the ICU constantly strive to achieve the best clinical outcome for their patients, they are also in a unique position to help facilitate meaningful, personalized, and humane deaths. “3 Wishes” is an intervention that can honor the patient and facilitate the grieving process for family members. DISCLOSURES: No relevant relationships by Neha Agarwal, source=Web Response No relevant relationships by Kristen Hjelmhaug, source=Web Response No relevant relationships by YUHAN KAO, source=Web Response No relevant relationships by Thanh Neville, source=Web Response No relevant relationships by Peter Phung, source=Web Response No relevant relationships by Allison Ramsey, source=Web Response No relevant relationships by Xueqing Xu, source=Web Response