Utilization of the "3 Wishes Project" to Enhance Individualization of End-of-Life Care in a Medical Intensive Care Unit

Background. Multiple nursing and medical organizations recommend that individualized end-of-life (EOL) care should be standard practice. However, a standardized approach does not exist because EOL care should be individually tailored. The “3 Wishes Project” (3WP) is an EOL intervention that provides direction for individualized EOL care. 3WP has 3 goals: dignify death, celebrate the patient’s life, and support family members and the intensive care unit (ICU) clinicians caring for the patient. Patients and/or families are given the opportunity to choose 3 wishes during the dying process.

Objective. The purpose of the project was to determine if the implementation of the 3WP allowed the medical team to provide individualized EOL care.

Methods. The IOWA model was used for this evidence-based project. The project was implemented in the Medical ICU at an academic medical center. Outcomes were evaluated by the collection and analysis of qualitative and quantitative data.

Results. 57 patients died during the 2-month implementation period. 31 patients participated and 1 declined. Overall participation was 55%. Top 5 wishes were cloth hearts, blanket, heart beat printouts, fingerprints/handprints, and music. The total cost was $940 and the cost per wish was $6.98. Approximately 85% of the 39 survey respondents indicated that they either agreed or strongly agreed that the project allowed the medical team to consistently provide individualized EOL care.

Conclusions. The survey data supports the 3WP as a method that allowed the medical team to individualize EOL care and is a valuable tool for incorporation at the bedside.