November 11, 2019 / 10:45 PM / a month ago

Granting dying patients' wishes may help families feel better about end-of-life ICU care

(Reuters Health) - Families of dying patients may feel better about end-of-life care in the ICU if they are granted simple wishes, like letting the patient taste a favorite meal or use a blanket from home, a small study suggests.

Researchers interviewed families and caregivers of 730 terminally ill patients about their experiences with the 3 Wishes Project (3WP), a program designed to create meaningful patient- and family-centered memories as part of compassionate end-of-life care.

“3WP facilitates compassionate care by recognizing the inherent dignity of dying patients and encouraging connections among patients, clinicians, and family members,” Dr. Deborah Cook of McMaster University in Hamilton, Ontario, and colleagues write in the Annals of Internal Medicine.

The goal of the study was to see how feasible it might be to implement the 3WP program at multiple facilities, how much families and clinicians appreciated the experiences, and how much it might cost to grant wishes to dying patients and their families on a regular basis.

The program focused on dying patients in intensive care units at four hospitals. Most required mechanical ventilation to breathe as well as medication to help their heart pump blood. Many were also on dialysis because their kidneys were failing.

Wishes varied widely and included things like taking patients outdoors, putting up seasonal decorations in hospital rooms, celebrating occasions like birthdays or anniversaries, renewing wedding vows, allowing for unlimited visitors, or assisting with legacies like organ donation or blood drives.

Overall, 3,325 wishes were granted. On averages, wishes cost only $5.19 apiece. Granting wishes appeared sustainable, given that hospitals continued to offer the 3WP program even after the study year ended.

Family members and clinicians interviewed about 3WP felt the wishes helped foster human connection and helped family, friends, and caregivers focus on patients’ identities as unique individuals.

This runs counter to sterile intensive care environment where illness severity, reliance on technology, and patients’ inability to communicate can make it hard to deliver optimal end-of-life care, the study team writes.

Family members were comforted by having the opportunity to connect with each other and forge meaningful relationships with clinicians, appreciating clinicians’ explicit recognition of the dignity of their loved ones, researchers note.

Memory-making activities embedded in 3WP catalyze respectful care that may encourage families to recall positive memories of their loved one as a person, not a patient, which may ease grief, researchers also point out.

Focusing on connection and legacy may help ease some of the grief, stress, depression, and anxiety experienced by people whose family members die in the ICU, researchers note.

Humanizing the ICU experience for dying patients may also help address the needs of staff members who have high levels of burnout and distress, the study team writes. Clinicians’ negative experiences and feelings can be exacerbated when dying patients receive care that’s inconsistent with their wishes or prognosis or when communication with families doesn’t clarify what might help make the best of a bad situation. With 3WP, clinicians and families have a framework to collaborate in honoring patients during their final days, which may help improve job satisfaction for clinicians.

One limitation of the study is that most patients were incapacitated and unable to respond to wishes or participate in interviews about the experiences, the study team notes. This means the program was evaluated based on its impact only on families and caregivers.

SOURCE: bit.ly/2rA3QHF Annals of Internal Medicine, online November 11, 2019.

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