Initiating and integrating a personalized end of life care project in a community hospital intensive care unit: A qualitative study of clinician and implementation team perspectives

Abstract

Rationale: The end of life (EOL) experience in the intensive care unit (ICU) can be psychologically distressing for patients, families, and clinicians. The 3 Wishes Project (3WP) personalizes the EOL experience by carrying out wishes for dying patients and their families. While the 3WP has been integrated in academic, tertiary care ICUs, implementing this project in a community ICU has yet to be described.Objectives: To examine facilitators of, and barriers to, implementing the 3WP in a community ICU from the clinician and implementation team perspective.Methods: This qualitative descriptive study evaluated the implementation of the 3WP in a 20-bed community ICU in Southern Ontario, Canada. Patients were considered for the 3WP if they had a high likelihood of imminent death or planned withdrawal of life-sustaining therapy. Following the qualitative descriptive approach, semi-structured interviews were conducted with purposively sampled clinicians and implementation team. Data from transcribed interviews were analyzed in triplicate through qualitative content analysis.Results: Interviews with 12 participants indicated that the 3WP personalized and enriched the EOL experience. Interviewees indicated higher intensity education strategies were needed to enable spread as the project grew. Clinicians described many physical resources for the project but suggested more non-clinical project support for orientation, continuing education, and data collection. A majority of wishes focused on physical resources including keepsakes, which helped facilitate project spread when clinician capacity was attenuated by competing duties. Conclusions:In this community hospital, ICU clinicians and implementation team members report perceived improved EOL care for patients, families, and clinicians following 3WP initiation and integration. Implementing individualized and meaningful wishes at EOL for dying patients in a community ICU requires adequate planning and time dedicated to optimizing clinician education. Adapting key features of an

The 3 Wishes Program Improves Families’ Experience of Emotional and Spiritual Support at the End of Life

“…However, the 3WP has been implemented in multi-center studies, 18 , 19 , 23 including community hospitals. 38 , 39 Although our response rate was low (30%), this is not uncommon for studies evaluating the quality of dying that are outside the integrated VA system. 40 – 42 …”

The 3 Wishes Program Improves Families’ Experience of Emotional and Spiritual Support at the End-Of-Life

“…However, the 3WP has been implemented in multicenter studies, 18,19,23 including community hospitals. 38,39 Although our response rate was low (30%), this is not uncommon for studies evaluating the quality of dying that are outside the integrated VA system. [40][41][42] Although a simple concept, the 3WP seeks to change the perspective around death, such that dying is also seen as an opportunity to honor a patient's wishes, celebrate the patient's life, and create peaceful memories during final moments.…”

Palliative-Care-Konzepte für Patienten und Familien

“…Im Mittelpunkt stehen die Person und das individuelle Leben des Sterbenden. Die Wünsche konzentrieren sich auf die humane Gestaltung der unmittelbaren Umgebung des Patienten und die Schaffung positiver Erinnerungen 45 47 – 49 . In der Forschung zur Gestaltung von Erinnerungsstücken wird betont, dass nicht nur das Erinnerungsstück als Andenken einen Wert für die Familienmitglieder hat, sondern auch der Prozess der Gestaltung Hoffnung gibt und die Beziehung zum Behandlungsteam vertieft.…”

“…Aus der vorliegenden Studienlage lassen sich keine evidenzbasierten Empfehlungen für oder gegen eines der beiden genannten Verfahren ableiten. Vielmehr wird in der intensivmedizinischen Praxis die Entscheidung über die Art der Beendigung der maschinellen bung des Patienten und die Schaffung positiver Erinnerungen[45][47][48][49]. In der Forschung zur Gestaltung von Erinnerungsstücken wird betont, dass nicht nur das Erinnerungsstück als Andenken einen Wert für die Familienmitglieder hat, sondern auch der Prozess der Gestaltung Hoffnung gibt und die Beziehung zum Behandlungsteam dere Bedeutung der Erstellung liegt darin, dass die Familienmitglieder gebeten werden, Begriffe und Wörter zu finden, die den sterbenden Menschen, sein Leben, seine Leidenschaften und Werte repräsentieren.…”