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McMaster Faculty of Health Sciences Newsmagazine — Volume 9, Issue 3, Fall 2015

Bringing peace to those near death

Asking for and honouring last wishes helps to create meaning, memories and closure at death, and personalizes the dying process for patients and their families, says a recent study led by Deborah Cook, a professor of medicine and clinical epidemiology and biostatistics.

The research, published this week in the Annals of Internal Medicine, is about the Three Wishes Project initiated by Cook, who is lead author and also a staff physician in the Intensive Care Unit (ICU) at St. Joseph's Healthcare Hamilton.

The ongoing project involves the patient's clinician or a researcher 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 fulfill them.

We developed this project to try to bring peace to the final days of critically ill patients and to ease the grieving process. 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-centred care.

— Deborah Cook

Melanie Wolfe's father, Bill Morrell, went into hypoxic arrest at St. Joseph's in April and was placed on life support.

Knowing the outcome wouldn't be good, her family's three wishes were that he be kept alive long enough for his brother and sister to arrive from Australia; that the family have a private room of their own to meet in; and that one last photo of her father with his family be taken.

Morrell was in the ICU for four days and his siblings arrived on the fourth day.

Wolfe says her aunt and uncle being able to say their goodbyes "meant the world to them because they didn't have that closure before when my uncle passed away" about 10 years earlier.

As part of the project, staff also helped the family create a word cloud describing Morrell and had copies framed for Wolfe and her brother. To have that, along with the photo of the whole family surrounding him by his bed, is invaluable, Wolfe said.

"When you're in the ICU and all you are doing is worrying, the staff are amazing at explaining everything to you and being there for you and answering all your questions, but we knew we were leaving without him and so Dr. Cook's project just meant everything to us because we left with something," said Wolfe. "I know that sounds so crazy, but all of those words encompassed his spirit and his livelihood and everything about him. We feel proud to display it on our mantel and it's just … for not wanting to be in that situation, it made you feel better about how everything went and helped with the grieving process."

Cook's study took place at the St. Joseph's ICU. Participants included 40 dying patients, at least one family member per patient, and three clinicians per patient.

The wishes were summarized as being in five areas:

  • Humanizing the environment (such as bringing favourite flowers or cherished mementoes 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 98 per cent of the requested wishes were implemented, at a cost ranging from nothing 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.

As one 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."