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Abstract
Discussion Forum (0)
ePoster
Topic: End-of-Life and Supportive Care
Yeung, Eugenia1; Sadowski, Laurie2; Levesque, Kelsea3; Camargo, Mercedes4; Vo, Allen5; Davidson, Francie6; Young, Elayn7; Tsang, Jennifer8; Cook, Deborah9; Tam, Benjamin10
1 Department of Medicine, University of Ottawa, Ottawa, Canada
2 Arts in Medicine, Niagara Health, St. Catharines, Canada
3 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
4 Department of Health Sciences, Brock University, St. Catharines, Canada
5 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
6 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
7 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
8 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
9 Department of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
10 Department of Critical Care Medicine, Niagara Health, St. Cathrine's, Canada
University of Ottawa
INTRODUCTION:
The end of life (EOL) experience in the intensive care unit (ICU) can be a psychologically distressing and dehumanizing experience for patients, families and clinicians. The 3 Wishes Project (3WP) personalizes and promotes dignity during the EOL experience by carrying out wishes for dying patients and their families.1–3 While the 3WP has been successfully integrated in academic, tertiary care ICUs, implementing this project in large community hospitals has yet to be described.
Objectives
To examine facilitators of, and barriers to, implementing the 3WP in a community ICU from the clinician perspective.
Methods
This mixed-method 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. The quantitative research component of the project involved collecting patient demographic data and wishes performed; this occurred when the 3WP physician lead was on service, though there were no restrictions on wishes outside these times. Following the qualitative descriptive approach, a research assistant independent of project implementation conducted semi-structured interviewed with purposively sampled clinicians. After transcribing the interviews verbatim, data was analyzed in duplicate through qualitative content analysis, using inductive coding to derive categories and themes.
Results:
During the 10-month period, 66 of 67 wishes (98.5%) were completed, with a median of 4.5 wishes per patient-family dyad. Interview data with 12 clinicians indicated that the 3WP personalized patient and family experience at EOL, and enriched clinician experience delivering EOL care. Clinicians indicated that education strategies were needed to enable scaling as the program grew and suggested approaches such as distribution of standardized protocols, education sessions during work hours, and sustained communication through all project phases. Clinicians noted an abundance of physical resources associated with the program but a lack of a non-clinical project support for education and data collection while moving through the initiation period to wide-spread project use. Instead, these roles were completed by clinicians with saturated work capacity which may have inhibited sustainable scale up.
Conclusions:
In this community hospital, ICU clinicians reported the 3WP improved EOL care for patients, families, and clinicians. Implementation of this program at scale requires proportionate and multi-modal education, as well as consistent communication with staff. Wishes with minimal impact on clinician workload facilitate program growth in an environment where human resources to support the scaling process are sparse.
References
1. Vanstone, M. et al. Compassionate End-of-Life Care: Mixed-Methods Multisite Evaluation of the 3 Wishes Project. Ann. Intern. Med. (2019). doi:10.7326/M19-2438
2. Cook, D. et al. Personalizing death in the intensive care unit: The 3 wishes project a mixed-methods study. Ann. Intern. Med. 163, 271–279 (2015).
3. Vanstone, M., Neville, T., Swinton, M., Sadik, M., Clarke, F., LeBlanc, A., Tam, B., Takaoka, A., Hoad, N., Hancock, J., McMullen, S., Reeve, B., Dechert, W., Smith, O., Sandhu, G., Lockington, J., Cook, D. Expanding the 3 Wishes Project for compassionate end-of-life care: A qualitative evaluation of local adaptations. BMC Palliat. Care (2020).
Topic: End-of-Life and Supportive Care
Yeung, Eugenia1; Sadowski, Laurie2; Levesque, Kelsea3; Camargo, Mercedes4; Vo, Allen5; Davidson, Francie6; Young, Elayn7; Tsang, Jennifer8; Cook, Deborah9; Tam, Benjamin10
1 Department of Medicine, University of Ottawa, Ottawa, Canada
2 Arts in Medicine, Niagara Health, St. Catharines, Canada
3 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
4 Department of Health Sciences, Brock University, St. Catharines, Canada
5 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
6 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
7 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
8 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
9 Department of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
10 Department of Critical Care Medicine, Niagara Health, St. Cathrine's, Canada
University of Ottawa
INTRODUCTION:
The end of life (EOL) experience in the intensive care unit (ICU) can be a psychologically distressing and dehumanizing experience for patients, families and clinicians. The 3 Wishes Project (3WP) personalizes and promotes dignity during the EOL experience by carrying out wishes for dying patients and their families.1–3 While the 3WP has been successfully integrated in academic, tertiary care ICUs, implementing this project in large community hospitals has yet to be described.
Objectives
To examine facilitators of, and barriers to, implementing the 3WP in a community ICU from the clinician perspective.
Methods
This mixed-method 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. The quantitative research component of the project involved collecting patient demographic data and wishes performed; this occurred when the 3WP physician lead was on service, though there were no restrictions on wishes outside these times. Following the qualitative descriptive approach, a research assistant independent of project implementation conducted semi-structured interviewed with purposively sampled clinicians. After transcribing the interviews verbatim, data was analyzed in duplicate through qualitative content analysis, using inductive coding to derive categories and themes.
Results:
During the 10-month period, 66 of 67 wishes (98.5%) were completed, with a median of 4.5 wishes per patient-family dyad. Interview data with 12 clinicians indicated that the 3WP personalized patient and family experience at EOL, and enriched clinician experience delivering EOL care. Clinicians indicated that education strategies were needed to enable scaling as the program grew and suggested approaches such as distribution of standardized protocols, education sessions during work hours, and sustained communication through all project phases. Clinicians noted an abundance of physical resources associated with the program but a lack of a non-clinical project support for education and data collection while moving through the initiation period to wide-spread project use. Instead, these roles were completed by clinicians with saturated work capacity which may have inhibited sustainable scale up.
Conclusions:
In this community hospital, ICU clinicians reported the 3WP improved EOL care for patients, families, and clinicians. Implementation of this program at scale requires proportionate and multi-modal education, as well as consistent communication with staff. Wishes with minimal impact on clinician workload facilitate program growth in an environment where human resources to support the scaling process are sparse.
References
1. Vanstone, M. et al. Compassionate End-of-Life Care: Mixed-Methods Multisite Evaluation of the 3 Wishes Project. Ann. Intern. Med. (2019). doi:10.7326/M19-2438
2. Cook, D. et al. Personalizing death in the intensive care unit: The 3 wishes project a mixed-methods study. Ann. Intern. Med. 163, 271–279 (2015).
3. Vanstone, M., Neville, T., Swinton, M., Sadik, M., Clarke, F., LeBlanc, A., Tam, B., Takaoka, A., Hoad, N., Hancock, J., McMullen, S., Reeve, B., Dechert, W., Smith, O., Sandhu, G., Lockington, J., Cook, D. Expanding the 3 Wishes Project for compassionate end-of-life care: A qualitative evaluation of local adaptations. BMC Palliat. Care (2020).
ePoster
Topic: End-of-Life and Supportive Care
Yeung, Eugenia1; Sadowski, Laurie2; Levesque, Kelsea3; Camargo, Mercedes4; Vo, Allen5; Davidson, Francie6; Young, Elayn7; Tsang, Jennifer8; Cook, Deborah9; Tam, Benjamin10
1 Department of Medicine, University of Ottawa, Ottawa, Canada
2 Arts in Medicine, Niagara Health, St. Catharines, Canada
3 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
4 Department of Health Sciences, Brock University, St. Catharines, Canada
5 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
6 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
7 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
8 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
9 Department of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
10 Department of Critical Care Medicine, Niagara Health, St. Cathrine's, Canada
University of Ottawa
INTRODUCTION:
The end of life (EOL) experience in the intensive care unit (ICU) can be a psychologically distressing and dehumanizing experience for patients, families and clinicians. The 3 Wishes Project (3WP) personalizes and promotes dignity during the EOL experience by carrying out wishes for dying patients and their families.1–3 While the 3WP has been successfully integrated in academic, tertiary care ICUs, implementing this project in large community hospitals has yet to be described.
Objectives
To examine facilitators of, and barriers to, implementing the 3WP in a community ICU from the clinician perspective.
Methods
This mixed-method 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. The quantitative research component of the project involved collecting patient demographic data and wishes performed; this occurred when the 3WP physician lead was on service, though there were no restrictions on wishes outside these times. Following the qualitative descriptive approach, a research assistant independent of project implementation conducted semi-structured interviewed with purposively sampled clinicians. After transcribing the interviews verbatim, data was analyzed in duplicate through qualitative content analysis, using inductive coding to derive categories and themes.
Results:
During the 10-month period, 66 of 67 wishes (98.5%) were completed, with a median of 4.5 wishes per patient-family dyad. Interview data with 12 clinicians indicated that the 3WP personalized patient and family experience at EOL, and enriched clinician experience delivering EOL care. Clinicians indicated that education strategies were needed to enable scaling as the program grew and suggested approaches such as distribution of standardized protocols, education sessions during work hours, and sustained communication through all project phases. Clinicians noted an abundance of physical resources associated with the program but a lack of a non-clinical project support for education and data collection while moving through the initiation period to wide-spread project use. Instead, these roles were completed by clinicians with saturated work capacity which may have inhibited sustainable scale up.
Conclusions:
In this community hospital, ICU clinicians reported the 3WP improved EOL care for patients, families, and clinicians. Implementation of this program at scale requires proportionate and multi-modal education, as well as consistent communication with staff. Wishes with minimal impact on clinician workload facilitate program growth in an environment where human resources to support the scaling process are sparse.
References
1. Vanstone, M. et al. Compassionate End-of-Life Care: Mixed-Methods Multisite Evaluation of the 3 Wishes Project. Ann. Intern. Med. (2019). doi:10.7326/M19-2438
2. Cook, D. et al. Personalizing death in the intensive care unit: The 3 wishes project a mixed-methods study. Ann. Intern. Med. 163, 271–279 (2015).
3. Vanstone, M., Neville, T., Swinton, M., Sadik, M., Clarke, F., LeBlanc, A., Tam, B., Takaoka, A., Hoad, N., Hancock, J., McMullen, S., Reeve, B., Dechert, W., Smith, O., Sandhu, G., Lockington, J., Cook, D. Expanding the 3 Wishes Project for compassionate end-of-life care: A qualitative evaluation of local adaptations. BMC Palliat. Care (2020).
Topic: End-of-Life and Supportive Care
Yeung, Eugenia1; Sadowski, Laurie2; Levesque, Kelsea3; Camargo, Mercedes4; Vo, Allen5; Davidson, Francie6; Young, Elayn7; Tsang, Jennifer8; Cook, Deborah9; Tam, Benjamin10
1 Department of Medicine, University of Ottawa, Ottawa, Canada
2 Arts in Medicine, Niagara Health, St. Catharines, Canada
3 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
4 Department of Health Sciences, Brock University, St. Catharines, Canada
5 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
6 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
7 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
8 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
9 Department of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
10 Department of Critical Care Medicine, Niagara Health, St. Cathrine's, Canada
University of Ottawa
INTRODUCTION:
The end of life (EOL) experience in the intensive care unit (ICU) can be a psychologically distressing and dehumanizing experience for patients, families and clinicians. The 3 Wishes Project (3WP) personalizes and promotes dignity during the EOL experience by carrying out wishes for dying patients and their families.1–3 While the 3WP has been successfully integrated in academic, tertiary care ICUs, implementing this project in large community hospitals has yet to be described.
Objectives
To examine facilitators of, and barriers to, implementing the 3WP in a community ICU from the clinician perspective.
Methods
This mixed-method 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. The quantitative research component of the project involved collecting patient demographic data and wishes performed; this occurred when the 3WP physician lead was on service, though there were no restrictions on wishes outside these times. Following the qualitative descriptive approach, a research assistant independent of project implementation conducted semi-structured interviewed with purposively sampled clinicians. After transcribing the interviews verbatim, data was analyzed in duplicate through qualitative content analysis, using inductive coding to derive categories and themes.
Results:
During the 10-month period, 66 of 67 wishes (98.5%) were completed, with a median of 4.5 wishes per patient-family dyad. Interview data with 12 clinicians indicated that the 3WP personalized patient and family experience at EOL, and enriched clinician experience delivering EOL care. Clinicians indicated that education strategies were needed to enable scaling as the program grew and suggested approaches such as distribution of standardized protocols, education sessions during work hours, and sustained communication through all project phases. Clinicians noted an abundance of physical resources associated with the program but a lack of a non-clinical project support for education and data collection while moving through the initiation period to wide-spread project use. Instead, these roles were completed by clinicians with saturated work capacity which may have inhibited sustainable scale up.
Conclusions:
In this community hospital, ICU clinicians reported the 3WP improved EOL care for patients, families, and clinicians. Implementation of this program at scale requires proportionate and multi-modal education, as well as consistent communication with staff. Wishes with minimal impact on clinician workload facilitate program growth in an environment where human resources to support the scaling process are sparse.
References
1. Vanstone, M. et al. Compassionate End-of-Life Care: Mixed-Methods Multisite Evaluation of the 3 Wishes Project. Ann. Intern. Med. (2019). doi:10.7326/M19-2438
2. Cook, D. et al. Personalizing death in the intensive care unit: The 3 wishes project a mixed-methods study. Ann. Intern. Med. 163, 271–279 (2015).
3. Vanstone, M., Neville, T., Swinton, M., Sadik, M., Clarke, F., LeBlanc, A., Tam, B., Takaoka, A., Hoad, N., Hancock, J., McMullen, S., Reeve, B., Dechert, W., Smith, O., Sandhu, G., Lockington, J., Cook, D. Expanding the 3 Wishes Project for compassionate end-of-life care: A qualitative evaluation of local adaptations. BMC Palliat. Care (2020).
Clinician's Perspectives on The Implementation of a Personalized End of Life Program in a Community Hospital Intensive Care Unit: A Mixed-Method Study
Eugenia Yeung
Abstract
Discussion Forum (0)
ePoster
Topic: End-of-Life and Supportive Care
Yeung, Eugenia1; Sadowski, Laurie2; Levesque, Kelsea3; Camargo, Mercedes4; Vo, Allen5; Davidson, Francie6; Young, Elayn7; Tsang, Jennifer8; Cook, Deborah9; Tam, Benjamin10
1 Department of Medicine, University of Ottawa, Ottawa, Canada
2 Arts in Medicine, Niagara Health, St. Catharines, Canada
3 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
4 Department of Health Sciences, Brock University, St. Catharines, Canada
5 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
6 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
7 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
8 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
9 Department of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
10 Department of Critical Care Medicine, Niagara Health, St. Cathrine's, Canada
University of Ottawa
INTRODUCTION:
The end of life (EOL) experience in the intensive care unit (ICU) can be a psychologically distressing and dehumanizing experience for patients, families and clinicians. The 3 Wishes Project (3WP) personalizes and promotes dignity during the EOL experience by carrying out wishes for dying patients and their families.1–3 While the 3WP has been successfully integrated in academic, tertiary care ICUs, implementing this project in large community hospitals has yet to be described.
Objectives
To examine facilitators of, and barriers to, implementing the 3WP in a community ICU from the clinician perspective.
Methods
This mixed-method 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. The quantitative research component of the project involved collecting patient demographic data and wishes performed; this occurred when the 3WP physician lead was on service, though there were no restrictions on wishes outside these times. Following the qualitative descriptive approach, a research assistant independent of project implementation conducted semi-structured interviewed with purposively sampled clinicians. After transcribing the interviews verbatim, data was analyzed in duplicate through qualitative content analysis, using inductive coding to derive categories and themes.
Results:
During the 10-month period, 66 of 67 wishes (98.5%) were completed, with a median of 4.5 wishes per patient-family dyad. Interview data with 12 clinicians indicated that the 3WP personalized patient and family experience at EOL, and enriched clinician experience delivering EOL care. Clinicians indicated that education strategies were needed to enable scaling as the program grew and suggested approaches such as distribution of standardized protocols, education sessions during work hours, and sustained communication through all project phases. Clinicians noted an abundance of physical resources associated with the program but a lack of a non-clinical project support for education and data collection while moving through the initiation period to wide-spread project use. Instead, these roles were completed by clinicians with saturated work capacity which may have inhibited sustainable scale up.
Conclusions:
In this community hospital, ICU clinicians reported the 3WP improved EOL care for patients, families, and clinicians. Implementation of this program at scale requires proportionate and multi-modal education, as well as consistent communication with staff. Wishes with minimal impact on clinician workload facilitate program growth in an environment where human resources to support the scaling process are sparse.
References
1. Vanstone, M. et al. Compassionate End-of-Life Care: Mixed-Methods Multisite Evaluation of the 3 Wishes Project. Ann. Intern. Med. (2019). doi:10.7326/M19-2438
2. Cook, D. et al. Personalizing death in the intensive care unit: The 3 wishes project a mixed-methods study. Ann. Intern. Med. 163, 271–279 (2015).
3. Vanstone, M., Neville, T., Swinton, M., Sadik, M., Clarke, F., LeBlanc, A., Tam, B., Takaoka, A., Hoad, N., Hancock, J., McMullen, S., Reeve, B., Dechert, W., Smith, O., Sandhu, G., Lockington, J., Cook, D. Expanding the 3 Wishes Project for compassionate end-of-life care: A qualitative evaluation of local adaptations. BMC Palliat. Care (2020).
Topic: End-of-Life and Supportive Care
Yeung, Eugenia1; Sadowski, Laurie2; Levesque, Kelsea3; Camargo, Mercedes4; Vo, Allen5; Davidson, Francie6; Young, Elayn7; Tsang, Jennifer8; Cook, Deborah9; Tam, Benjamin10
1 Department of Medicine, University of Ottawa, Ottawa, Canada
2 Arts in Medicine, Niagara Health, St. Catharines, Canada
3 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
4 Department of Health Sciences, Brock University, St. Catharines, Canada
5 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
6 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
7 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
8 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
9 Department of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
10 Department of Critical Care Medicine, Niagara Health, St. Cathrine's, Canada
University of Ottawa
INTRODUCTION:
The end of life (EOL) experience in the intensive care unit (ICU) can be a psychologically distressing and dehumanizing experience for patients, families and clinicians. The 3 Wishes Project (3WP) personalizes and promotes dignity during the EOL experience by carrying out wishes for dying patients and their families.1–3 While the 3WP has been successfully integrated in academic, tertiary care ICUs, implementing this project in large community hospitals has yet to be described.
Objectives
To examine facilitators of, and barriers to, implementing the 3WP in a community ICU from the clinician perspective.
Methods
This mixed-method 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. The quantitative research component of the project involved collecting patient demographic data and wishes performed; this occurred when the 3WP physician lead was on service, though there were no restrictions on wishes outside these times. Following the qualitative descriptive approach, a research assistant independent of project implementation conducted semi-structured interviewed with purposively sampled clinicians. After transcribing the interviews verbatim, data was analyzed in duplicate through qualitative content analysis, using inductive coding to derive categories and themes.
Results:
During the 10-month period, 66 of 67 wishes (98.5%) were completed, with a median of 4.5 wishes per patient-family dyad. Interview data with 12 clinicians indicated that the 3WP personalized patient and family experience at EOL, and enriched clinician experience delivering EOL care. Clinicians indicated that education strategies were needed to enable scaling as the program grew and suggested approaches such as distribution of standardized protocols, education sessions during work hours, and sustained communication through all project phases. Clinicians noted an abundance of physical resources associated with the program but a lack of a non-clinical project support for education and data collection while moving through the initiation period to wide-spread project use. Instead, these roles were completed by clinicians with saturated work capacity which may have inhibited sustainable scale up.
Conclusions:
In this community hospital, ICU clinicians reported the 3WP improved EOL care for patients, families, and clinicians. Implementation of this program at scale requires proportionate and multi-modal education, as well as consistent communication with staff. Wishes with minimal impact on clinician workload facilitate program growth in an environment where human resources to support the scaling process are sparse.
References
1. Vanstone, M. et al. Compassionate End-of-Life Care: Mixed-Methods Multisite Evaluation of the 3 Wishes Project. Ann. Intern. Med. (2019). doi:10.7326/M19-2438
2. Cook, D. et al. Personalizing death in the intensive care unit: The 3 wishes project a mixed-methods study. Ann. Intern. Med. 163, 271–279 (2015).
3. Vanstone, M., Neville, T., Swinton, M., Sadik, M., Clarke, F., LeBlanc, A., Tam, B., Takaoka, A., Hoad, N., Hancock, J., McMullen, S., Reeve, B., Dechert, W., Smith, O., Sandhu, G., Lockington, J., Cook, D. Expanding the 3 Wishes Project for compassionate end-of-life care: A qualitative evaluation of local adaptations. BMC Palliat. Care (2020).
ePoster
Topic: End-of-Life and Supportive Care
Yeung, Eugenia1; Sadowski, Laurie2; Levesque, Kelsea3; Camargo, Mercedes4; Vo, Allen5; Davidson, Francie6; Young, Elayn7; Tsang, Jennifer8; Cook, Deborah9; Tam, Benjamin10
1 Department of Medicine, University of Ottawa, Ottawa, Canada
2 Arts in Medicine, Niagara Health, St. Catharines, Canada
3 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
4 Department of Health Sciences, Brock University, St. Catharines, Canada
5 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
6 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
7 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
8 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
9 Department of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
10 Department of Critical Care Medicine, Niagara Health, St. Cathrine's, Canada
University of Ottawa
INTRODUCTION:
The end of life (EOL) experience in the intensive care unit (ICU) can be a psychologically distressing and dehumanizing experience for patients, families and clinicians. The 3 Wishes Project (3WP) personalizes and promotes dignity during the EOL experience by carrying out wishes for dying patients and their families.1–3 While the 3WP has been successfully integrated in academic, tertiary care ICUs, implementing this project in large community hospitals has yet to be described.
Objectives
To examine facilitators of, and barriers to, implementing the 3WP in a community ICU from the clinician perspective.
Methods
This mixed-method 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. The quantitative research component of the project involved collecting patient demographic data and wishes performed; this occurred when the 3WP physician lead was on service, though there were no restrictions on wishes outside these times. Following the qualitative descriptive approach, a research assistant independent of project implementation conducted semi-structured interviewed with purposively sampled clinicians. After transcribing the interviews verbatim, data was analyzed in duplicate through qualitative content analysis, using inductive coding to derive categories and themes.
Results:
During the 10-month period, 66 of 67 wishes (98.5%) were completed, with a median of 4.5 wishes per patient-family dyad. Interview data with 12 clinicians indicated that the 3WP personalized patient and family experience at EOL, and enriched clinician experience delivering EOL care. Clinicians indicated that education strategies were needed to enable scaling as the program grew and suggested approaches such as distribution of standardized protocols, education sessions during work hours, and sustained communication through all project phases. Clinicians noted an abundance of physical resources associated with the program but a lack of a non-clinical project support for education and data collection while moving through the initiation period to wide-spread project use. Instead, these roles were completed by clinicians with saturated work capacity which may have inhibited sustainable scale up.
Conclusions:
In this community hospital, ICU clinicians reported the 3WP improved EOL care for patients, families, and clinicians. Implementation of this program at scale requires proportionate and multi-modal education, as well as consistent communication with staff. Wishes with minimal impact on clinician workload facilitate program growth in an environment where human resources to support the scaling process are sparse.
References
1. Vanstone, M. et al. Compassionate End-of-Life Care: Mixed-Methods Multisite Evaluation of the 3 Wishes Project. Ann. Intern. Med. (2019). doi:10.7326/M19-2438
2. Cook, D. et al. Personalizing death in the intensive care unit: The 3 wishes project a mixed-methods study. Ann. Intern. Med. 163, 271–279 (2015).
3. Vanstone, M., Neville, T., Swinton, M., Sadik, M., Clarke, F., LeBlanc, A., Tam, B., Takaoka, A., Hoad, N., Hancock, J., McMullen, S., Reeve, B., Dechert, W., Smith, O., Sandhu, G., Lockington, J., Cook, D. Expanding the 3 Wishes Project for compassionate end-of-life care: A qualitative evaluation of local adaptations. BMC Palliat. Care (2020).
Topic: End-of-Life and Supportive Care
Yeung, Eugenia1; Sadowski, Laurie2; Levesque, Kelsea3; Camargo, Mercedes4; Vo, Allen5; Davidson, Francie6; Young, Elayn7; Tsang, Jennifer8; Cook, Deborah9; Tam, Benjamin10
1 Department of Medicine, University of Ottawa, Ottawa, Canada
2 Arts in Medicine, Niagara Health, St. Catharines, Canada
3 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
4 Department of Health Sciences, Brock University, St. Catharines, Canada
5 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
6 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
7 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
8 Department of Critical Care Medicine, Niagara Health, St. Catharines, Canada
9 Department of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
10 Department of Critical Care Medicine, Niagara Health, St. Cathrine's, Canada
University of Ottawa
INTRODUCTION:
The end of life (EOL) experience in the intensive care unit (ICU) can be a psychologically distressing and dehumanizing experience for patients, families and clinicians. The 3 Wishes Project (3WP) personalizes and promotes dignity during the EOL experience by carrying out wishes for dying patients and their families.1–3 While the 3WP has been successfully integrated in academic, tertiary care ICUs, implementing this project in large community hospitals has yet to be described.
Objectives
To examine facilitators of, and barriers to, implementing the 3WP in a community ICU from the clinician perspective.
Methods
This mixed-method 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. The quantitative research component of the project involved collecting patient demographic data and wishes performed; this occurred when the 3WP physician lead was on service, though there were no restrictions on wishes outside these times. Following the qualitative descriptive approach, a research assistant independent of project implementation conducted semi-structured interviewed with purposively sampled clinicians. After transcribing the interviews verbatim, data was analyzed in duplicate through qualitative content analysis, using inductive coding to derive categories and themes.
Results:
During the 10-month period, 66 of 67 wishes (98.5%) were completed, with a median of 4.5 wishes per patient-family dyad. Interview data with 12 clinicians indicated that the 3WP personalized patient and family experience at EOL, and enriched clinician experience delivering EOL care. Clinicians indicated that education strategies were needed to enable scaling as the program grew and suggested approaches such as distribution of standardized protocols, education sessions during work hours, and sustained communication through all project phases. Clinicians noted an abundance of physical resources associated with the program but a lack of a non-clinical project support for education and data collection while moving through the initiation period to wide-spread project use. Instead, these roles were completed by clinicians with saturated work capacity which may have inhibited sustainable scale up.
Conclusions:
In this community hospital, ICU clinicians reported the 3WP improved EOL care for patients, families, and clinicians. Implementation of this program at scale requires proportionate and multi-modal education, as well as consistent communication with staff. Wishes with minimal impact on clinician workload facilitate program growth in an environment where human resources to support the scaling process are sparse.
References
1. Vanstone, M. et al. Compassionate End-of-Life Care: Mixed-Methods Multisite Evaluation of the 3 Wishes Project. Ann. Intern. Med. (2019). doi:10.7326/M19-2438
2. Cook, D. et al. Personalizing death in the intensive care unit: The 3 wishes project a mixed-methods study. Ann. Intern. Med. 163, 271–279 (2015).
3. Vanstone, M., Neville, T., Swinton, M., Sadik, M., Clarke, F., LeBlanc, A., Tam, B., Takaoka, A., Hoad, N., Hancock, J., McMullen, S., Reeve, B., Dechert, W., Smith, O., Sandhu, G., Lockington, J., Cook, D. Expanding the 3 Wishes Project for compassionate end-of-life care: A qualitative evaluation of local adaptations. BMC Palliat. Care (2020).
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