Improving Clinicians' Experience of End-of-Life Care in the Intensive Care Unit Through Implementation of the ‘3 Wishes Project'

Background: The '3 Wishes Project,' is an end-of-life program meant to bring humanity and dignity to dying patients, while encouraging meaningful connection and multidisciplinary communication among clinicians. The purpose of this project was to improve clinician experience of end-of-life care in the intensive care unit through implementation of the ‘3 Wishes Project.' Local Problem: Death in the intensive care unit can be a source of moral distress for clinicians, especially when mortality rates are high and poor-quality dying experiences are perceived. End- of-life care interventions that add meaning to the dying process are necessary in order to decrease this emotional toll on healthcare workers, which can lead to eventual burnout. Methods: The author conducted a pre-implementation survey, provided unit-wide education using the toolkit, implemented the intervention, and then conducted a post-implementation survey at the end of the pilot period. Survey data was compared to assess for change in provider satisfaction regarding end-of-life care on the unit. The post-implementation survey also assessed the intervention, as well as the useability, feasibility, and satisfaction of the toolkit. Interventions: The focus of this quality improvement project was to implement the ‘3 Wishes Project' in the Medical Intensive Care Unit (MICU) at the University of Utah Hospital. An educational toolkit was developed, which established project structure and guided implementation. Results: Overall, clinician experience of end-of-life care improved after the implementation of the ‘3 Wishes Project.' Clinician experience was measured using four different metrics: end-of- life care provided on the MICU, interprofessional communication regarding end-of-life care plans, communication between clinicians and patients/families regarding end-of-life care, and the end-of-life care services offered on the MICU. A statistically significant (p's <0.05) difference was observed for each of the four measures from pre- to post-implementation, with the most significant being ‘the end-of-life care services offered on the MICU.' Regarding the intervention, clinicians reported a meaningful impact on the ICU team, the patients/families, and their professional morale and job satisfaction after implementation; and the educational toolkit was an accessible, effective, and useful tool for implementing the ‘3 Wishes Project'. Conclusion: The ‘3 Wishes Project' is a simple intervention which facilitated meaningful end- of-life care and positively impacted the experience of MICU clinicians. This may prove to be a factor in reducing occupational distress and burnout, which will need to be further assessed over a longer study period.