'Three Wishes Project’ Helps to Create Meaning, Memories, and Closure at Death

Newswise — Asking for and honoring last wishes helps to create meaning, memories and closure at death, and personalizes the dying process for patients and their families, says a new study led by a professor of McMaster University in Hamilton, ON, Canada.

Research published July 13 in the Annals of Internal Medicine is about the Three Wishes Project initiated by lead author Deborah Cook, a professor of medicine and clinical epidemiology and biostatistics with the Michael G. DeGroote School of Medicine and a staff physician in the intensive care unit (ICU) at St. Joseph's Healthcare Hamilton.

The project involved a researcher or patient’s clinician sensitively eliciting three wishes to best honour the dying person from the patient, the family or other clinicians caring for the patient, and then finding a way to honour them.

“We developed this project to try to bring peace to the final days of critically ill patients and to ease the grieving process,” said Cook. “For the patients we wanted to dignify their deaths and celebrate their lives; for family members, to humanize the dying experience and create positive memories; and for clinicians, to foster patient and family-centered care.”

The study took place at the ICU of St. Joseph’s Healthcare Hamilton. Participants in the study included 40 dying patients, at least one family member per patient, and three clinicians per patient.

The wishes were later categorized in five areas:• humanizing the environment (such as bringing favorite flowers or cherished mementos into the room);• personal tributes (such as having a tea party or planting a tree in the patient’s name);• family reconnections (such as locating a lost relative); • rituals and observances (having blessings or renewal of wedding vows); • paying it forward (such as organ donation or charitable giving).

Cook’s research team interviewed families and clinicians to assess the program and found that 97.5 per cent of the requested wishes were implemented, at a cost ranging from $0 to $200 per patient.

End-of-life care was rated high by family members and post-mortem interviews with 160 family members and clinicians provided overwhelmingly positive feedback.

One patient’s son said: “It gave me peace that final day – the way she went…I think that’s actually helped me in the long run…I believe it’s because the death process – the dignity that was given to her and the compassion that was shown to her family – made it much easier to deal with.”

A medical resident said: “It did make the experience seem dignified and peaceful. It didn’t necessarily feel like we were letting someone go; it felt more like we were wishing someone well.”

The study was supported by the Hamilton Academy of Health Science Research Organization and the Canadian Intensive Care Foundation.

Editors: Hospital staff and family members involved in the 'Three Wishes Project' are available for interviews.