Clinical question: Can we dignify death in the ICU and ease the grieving process by soliciting wishes from patients, families, and care team members?
Background: The death of the critically ill patient in the ICU can be dehumanizing and overwhelming for the patient’s family and friends, leading to prolonged physical and psychological stress. These deaths might have similar effects on the clinicians caring for the patients.
Study design: Mixed methods.
Setting: Medical-surgical ICU at a 21-bed, academic tertiary medical center in Ontario, Canada.
Synopsis: Semi-structured interviews were conducted with at least one family member and three clinicians per patient. A total of 40 patients were screened and deemed eligible for inclusion. Only seven patients were able to provide input on the wishes or interviews; the others had impaired consciousness. The team obtained 163 wishes from those individuals, and was able to implement 159 of them (97.5%). At least three wishes from each patient-family dyad were implemented.
The wishes were classified into five categories:
- Humanizing the environment;
- Personal tributes;
- Family reconnections;
- Rituals and observances; and
- Paying it forward.
These wishes were implemented before (51.6%) and after (48.4%) death and were generally inexpensive (less than $200 per patient).
From the 160 interviews of 170 individuals, the central theme that emerged was personalization of the dying process in the ICU through three related domains: dignifying the patient, giving the family a voice, and fostering clinician compassion.
The 3 Wishes Project provides a framework to foster discussion among care team members and families to ensure personalization and dignity in the dying process.
Bottom line: Solicitation of wishes from dying patients, their families, and their care team members can have a positive impact by allowing individualized end-of-life care.
Citation: Cook D, Swinton M, Toledo F, et al. Personalizing death in the intensive care unit: the 3 Wishes Project: a mixed-methods study. Ann Intern Med. 2015;163(4):271-279.