Building organizational compassion among teams delivering end-of-life care in the intensive care unit: The 3 Wishes Project

Abstract

Background: The 3 Wishes Project is a semistructured program that improves the quality of care for patients dying in the intensive care unit by eliciting and implementing wishes. This simple intervention honors the legacy of patients and eases family grief, forging human connections between family members and clinicians. Aim: To examine how the 3 Wishes Project enables collective patterns of compassion between patients, families, clinicians, and managerial leaders in the intensive care unit. Design: Using a qualitative descriptive approach, interviews and focus groups were used to collect data from family members of dying patients, clinicians, and institutional leaders. Unconstrained directed qualitative content analysis was performed using Organizational Compassion as the analytic framework. Setting/participants: Four North American intensive care units, participants were 74 family members of dying patients, 72 frontline clinicians, and 20 managerial leaders. Results: The policies and processes of the 3 Wishes Project exemplify organizational compassion by supporting individuals in the intensive care unit to collectively notice, feel, and respond to suffering. As an intervention that enables and empowers clinicians to engage in acts of kindness to enhance end-of-life care, the 3 Wishes Project is particularly well situated to encourage collective responses to suffering and promote compassion between patients, family members, and clinicians. Conclusions: Examining the 3 Wishes Project through the lens of organizational compassion reveals the potential of this program to cultivate the capacity for people to collectively notice, feel, and respond to suffering. Our data document multidirectional demonstrations of compassion between clinicians and family members, forging the type of human connections that may foster resilience.

Sacrifice and solidarity: a qualitative study of family experiences of death and bereavement in critical care settings during the pandemic

“…The 3 Wishes Project is an EOL intervention aimed to honour dying patients and support families in grief. It has grown into a programme of research aimed at improving EOL care across critical and acute care settings 28–30. Many studies have emerged from the larger multicentre research programme,28–30 demonstrating feasibility, scalability, transferability and value.…”

End-of-Life Care During the Coronavirus Disease 2019 Pandemic: The 3 Wishes Program

“…We were unable to abstract and thus evaluate the effect of hospital census and the need for transfers on pandemic EOL care. Because prior studies have demonstrated many positive influences of the 3WP ( 13 – 15 ), we did not evaluate its effect on families during this study period, acknowledging the possibility that the 3WP was particularly valuable due to the tragic circumstances of the pandemic. The ability to provide compassionate care can help alleviate HCWs’ distress and enhance interpersonal connections during these unprecedented times ( 41 , 43 , 44 ) although this was not measured in this study.…”

Impact of Hospital Visitor Restrictions during the COVID-19 Pandemic

“…Close communication between families of acutely ill patients has been shown to improve psychological outcomes and lead to higher quality surrogate decision making surrounding the direction of care. 39,40 Electronic communication through phone calls or video conferencing was widely adopted by health care systems during the COVID-19 pandemic. 28 A study that evaluated the feasibility and acceptability of electronic communication for palliative care family meetings found that 80% of family members felt comfortable articulating questions and expressing thoughts throughout the meeting.…”