1. To improve the quality of the dying experience for patients and their families Overall Goal of The 3 Wishes Project

2. 3 Specific Objectives For patients, to dignify their death and celebrate their life For family members, to humanize the dying process and create positive memories For ICU clinicians, to foster patient and family-centered care and inspire a deeper sense of our vocation

3. Rationale this individualized approach to end of life care acknowledges that the dying person and their family members are uniquely human Design mixed-methods demonstration project Setting 21-bed closed university-affiliated medical- surgical ICU

4. Premise of the 3 Wishes Bringing a set of 3 wishes to fulfillment in the hope of bringing peace to the final days or hours of a patient’s life Wishes may be those of –the patient –their family members –ICU clinicians –3 Wishes team

5. Inclusion Criteria 1)Patients with >95% probability of dying during the ICU stay 2)Decision made to withdraw or withhold advanced life support in anticipation of death Exclusion Criteria 1)Serious psychological, psychiatric or language issue precluding engagement 2)Patient admitted to ICU for <12 hours 3)Patient or family declines

6. Mixed-Methods Design Qualitative Data Family & Clinician Interviews Letters & Field Notes Wish Interpretation Quantitative Data Patient Demographics & Life Supports Family & Clinician Demographics Family QEOL-10 Survey

7. What is a Wish? A wish is a Process…. And a Product A means to recognize the patient An example of dignity-conserving care A tangible expression of empathy An opportunity for reflection A vehicle for inter-professional care A manifestation of hope A therapeutic connection A transitional activity An expression of spirituality A secular prayer

8. Qualitative Results: Personalizing Dying in the ICU Dignifying The Patient Giving Voice To The Family Calling Forth Clinician Compassion

9. Humanizing the Environment Tributes Rituals Paying It Forward Connections Wish Categories

10. Humanizing the Environment TributesConnectionsRitualsPaying It Forward Favourite music Final toastFinding a lost relative Movie nightHospital volunteer position Using patient’s nickname or preferred name Word cloudSkype reunionRenewal of wedding vows Family & friend donations to 3 Wishes Personal keepsakes in the room Tea partyPet visitationWeddingContribution to charity important to the patient Flowers for the room Birthday cakeHosting final supper Firework display Organ donation

11. A special collaboration Spiritual Care Palliative Care Critical Care