Scientific Summary:

A Multicenter Implementation Study of the 3 Wishes Project

Despite the use of increasingly advanced health care technology to monitor, diagnose and treat frail older adults who become critically ill, poor outcomes following admission to the intensive care unit (ICU) are common, and many such patients die as a result of their illnesses. The 3 Wishes Demonstration Project was developed to bring peace to the final days of a critically ill patient’s life and to ease the grieving process for others. It involves sensitively eliciting and then implementing at least 3 wishes from patients, family members, and/or clinicians caring for the dying patient. We now propose the Multicenter 3 Wishes Project - a mixed-methods implementation and formative evaluation study of 100 dying critically ill patients and their caregivers. The objective is to evaluate the feasibility of enhancing the quality of the dying experience for frail, elderly ICU patients age 65 years or older, their families and their clinicians through implementation of the 3 Wishes Project in 2 hospitals. Feasibility will be demonstrated if this project is: 1) Scalable (is implemented by clinical rather than research staff in the original Hamilton ICU); 2) Transferrable (is implemented in a Toronto ICU by a different mix of inter-professional clinicians); and 3) Affordable (implemented on a budget of less than $60/patient-family dyad). Through interviews and focus groups, we will understand whether this approach is feasible to recognize the personhood, journey, story and preferences of each dying, frail, elderly patient and their family member.