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

Background: The end-of-life (EOL) experience in the intensive care unit (ICU) is emotionally challenging, and there are opportunities for improvement. The 3 Wishes Program (3WP) promotes the dignity of dying patients and their families by eliciting and implementing wishes at the EOL.

Aim: To assess whether the 3WP is associated with improved ratings of EOL care.

Program description: In the 3WP, clinicians elicit and fulfill simple wishes for dying patients and their families.

Setting: 2-hospital academic healthcare system.

Participants: Dying patients in the ICU and their families.

Program evaluation: A modified Bereaved Family Survey (BFS), a validated tool for measuring EOL care quality, was completed by families of ICU decedents approximately 3 months after death. We compared patients whose care involved the 3WP to those who did not using three BFS-derived measures: Respectful Care and Communication (5 questions), Emotional and Spiritual Support (3 questions), and the BFS-Performance Measure (BFS-PM, a single-item global measure of care).

Results: Of 314 completed surveys, 117 were for patients whose care included the 3WP. Bereaved families of 3WP patients rated the Emotional and Spiritual Support factor significantly higher (7.5 vs. 6.0, p = 0.003, adjusted p = 0.001) than those who did not receive the 3WP. The Respectful Care and Communication factor and BFS-PM were no different between groups.

Discussion: The 3WP is a low-cost intervention that may be a feasible strategy for improving the EOL experience.