Initiating and integrating a personalized end of life care project in a
community hospital intensive care unit: a mixed-method study of
clinician and key stakeholder perspectives
Abstract
Rationale The end of life (EOL) experience in the intensive care unit
(ICU) can be psychologically distressing. The 3 Wishes Project (3WP)
personalizes the EOL experience by carrying out wishes for dying
patients and their families. While the 3WP has been integrated in
academic, tertiary care ICUs, implementing this project in a community
ICU has yet to be described. Objectives To examine facilitators of, and
barriers to, implementing the 3WP in a community ICU from the clinician
and key-stakeholder 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. Quantitative data include patient demographic
data and wishes implemented. Following the qualitative descriptive
approach, semi-structured interviews were conducted with purposively
sampled clinicians and key-stakeholders. Data from transcribed
interviews were analyzed in triplicate through qualitative content
analysis. Results During the 10-month period, 66 of 67 wishes were
completed, with a median of 4.5 wishes per patient-family dyad.
Interviews with 12 participants indicated that the 3WP personalized and
enriched the EOL experience for patients, families and clinicians.
Interviewees indicated higher intensity education strategies were needed
to enable spread as the project grew. Clinicians described many physical
resources for the project but required more non-clinical project support
for orientation, continuing education and data collection. Instead,
these roles were completed by clinicians with saturated work capacity
which may have inhibited the spread of the project. Conclusions In this
community hospital, ICU clinicians and key stakeholders reported the 3WP
improved EOL care for patients, families, and clinicians. Project
implementation in a community ICU requires investigators take into
account project characteristics and adapt the intervention to the
community hospital context.