Personalizing death in the intensive care unit: the 3 Wishes Project: a mixed-methods study

Background: Dying in the complex, efficiency-driven environment of the intensive care unit can be dehumanizing for the patient and have profound, long-lasting consequences for all persons attendant to that death. Objective: To bring peace to the final days of a patient’s life and to ease the grieving process. Design: Mixed-methods study. Setting: 21-bed medical–surgical intensive care unit. Participants: Dying patients and their families and clinicians. Intervention: To honor each patient, a set of wishes was generated by patients, family members, or clinicians. The wishes were implemented before or after death by patients, families, clinicians (6 of whom were project team members), or the project team. Measurements: Quantitative data included demographic characteristics, processes of care, and scores on the Quality of End-of-Life Care–10 instrument. Semistructured interviews of family members and clinicians were transcribed verbatim, and qualitative description was used to analyze them. Results: Participants included 40 decedents, at least 1 family member per patient, and 3 clinicians per patient. The 159 wishes were implemented and classified into 5 categories: humanizing the environment, tributes, family reconnections, observances, and “paying it forward.” Scores on the Quality of End-of-Life Care–10 instrument were high. The central theme from 160 interviews of 170 persons was how the 3 Wishes Project personalized the dying process. For patients, eliciting and customizing the wishes honored them by celebrating their lives and dignify- ing their deaths. For families, it created positive memories and individualized end-of-life care for their loved ones. For clinicians, it promoted interprofessional care and humanism in practice. Limitation: Impaired consciousness limited understanding of patients’ viewpoints. Conclusion: The 3 Wishes Project facilitated personalization of the dying process through explicit integration of palliative and spiritual care into critical care practice.