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UCLA pilot project fulfills patient wishes to improve end-of-life experience
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Researchers at UCLA have launched a pilot project designed to fulfill small wishes from critically ill patients in hopes of improving their end-of-life experience.
Ronald Reagan UCLA Medical Center is the first hospital in the United States to adopt the 3 Wishes Project, which kicked off in December thanks to a $10,000 grant from California State University Institute for Palliative Care.
The program — offered to patients in the ICU — will expand later this year to include the oncology unit at UCLA Santa Monica Hospital.
HemOnc Today spoke with Peter G. Phung, MD, MBA, palliative care physician and assistant professor in the department of medicine at Ronald Reagan UCLA Medical Center, about how the program works, the benefits it provides to patients and their family members, and the impact the ability to fulfill patients’ wishes has on members of the clinical care team.
Question: How did this program come about?
Answer: The idea for this program was initiated by Debra Cook, MD, professor of medicine and clinical epidemiology and biostatistics at McMaster University in Canada. She and colleagues published a paper about the program in 2015 in Annals of Internal Medicine. I saw the paper during my fellowship and I made it my mission to bring this program to life at my home institution. When I began working at UCLA, I met with Thanh H. Neville, MD, MSHS, assistant professor in the division of pulmonary and critical care at David Geffen School of Medicine at UCLA. She and I collaborated to bring the program to the medical intensive care unit at UCLA.
Q: How does the program work ?
A: We identify patients with a greater than 95% chance of dying in the hospital. An involved provider — typically the bedside nurse or physician — will elicit wishes from the patient or the patient’s family members. We then do our best to fulfill these final wishes.
Q: What are some examples of wishes that have been fulfilled so far?
A: One patient was a chef and enjoyed making drinks during her career, so we bought sparkling sodas and different juices so the patient and her family could have a mixology party in the patient’s room. Another patient was having a birthday and asked for mariachi music. His room went from an understandably sad environment to a room filled with dancing and family members having a good time. Another patient simply wanted to spend time outside the hospital before he died. This was a logistical challenge but we made it happen. All of these examples are small doable acts by any provider or organization, but the 3 Wishes Project allows us to standardize this process to all eligible patients.
Q: What is the cost of the program?
A: We enrolled 53 patients within 6 months of starting the program, and the average cost was $30 per patient. We were surprised to find most of the wishes were either low in cost or cost nothing. Some patients simply wanted to spend their final moments with family or listen to their favorite song. Families are able to create new memories with their loved ones during a difficult time.
Q: What benefits does this service provide to patients and their families?
A: The end-of-life process for patients and family members can be emotionally overwhelming. Family members can have prolonged grief, posttraumatic distress disorder or guilt after their loved one dies in the hospital. Our hope with the 3 Wishes Project is to provide families opportunities to honor their loved ones, say their goodbyes and celebrate the life they lived. Family members have said how touched they were by this program and how thankful they were to be able to share memories with their loved one. The program also has had a significant impact on providers. We have surveyed providers and found the program increases their job satisfaction and sense of community. As providers, we want to show that we care about our patients. This project helps us do that.
Q: Can you talk about how the program will expand into a dedicated oncology unit?
A: The project already involves many patients with cancer, but only those who are transferred to the medical ICU. We plan to expand our program to the oncology unit at UCLA Santa Monica Hospital. We feel the cancer population is special because they often have multiple admissions to the hospital and develop close relationships with the oncology staff. We hope the 3 Wishes Project will help oncology providers show how much they care about their patients.
Q: C an other institutions do something similar?
A: The idea of eliciting and fulfilling wishes can be performed by any organization. The 3 Wishes Project helps standardize the approach for all eligible patients and empowers all levels of providers to be involved with the process. If another organization wants to begin a program similar to this, I would say the most important part is to find people who are really excited about improving care for this patient population and then come up with a process to elicit and fulfill wishes. Initially, the program felt overwhelming to us. Once we started and providers saw the effect on families, we have had an outpouring of support from people who want to be involved. Anyone interested in starting their own program can reach out to me. I will be happy to talk with them about creating their own program. – by Jennifer Southall
Reference:
Cook D, et al. Ann Intern Med. 2015;doi:10.7326/M15-0502.
For more information:
Peter G. Phung, MD, MBA , can be reached at Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Los Angeles, CA 90095; email: pphung@mednet.ucla.edu.
Thanh Neville, MD, MSHS, can be reached at UCLA Med-Pulm and Critical Care, Box 951690, 37-131 CHS, Los Angeles, CA 90095; email: tneville@mednet.ucla.edu.
Disclosure: Phung reports no relevant financial disclosures.