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Expanding the 3 Wishes Project for compassionate end-of-life care: a qualitative evaluation of local adaptations

BACKGROUND: The 3 Wishes Project (3WP) is an end-of-life program that honors the dignity of dying patients by fostering meaningful connections among patients, families, and clinicians. Since 2013, it has become embedded in the culture of end-of-life care in over 20 ICUs across North America. The pur...

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Autores principales: Vanstone, Meredith, Neville, Thanh H., Swinton, Marilyn E., Sadik, Marina, Clarke, France J., LeBlanc, Allana, Tam, Benjamin, Takaoka, Alyson, Hoad, Neala, Hancock, Jennifer, McMullen, Sarah, Reeve, Brenda, Dechert, William, Smith, Orla M., Sandhu, Gyan, Lockington, Julie, Cook, Deborah J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7325646/
https://www.ncbi.nlm.nih.gov/pubmed/32605623
http://dx.doi.org/10.1186/s12904-020-00601-5
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author Vanstone, Meredith
Neville, Thanh H.
Swinton, Marilyn E.
Sadik, Marina
Clarke, France J.
LeBlanc, Allana
Tam, Benjamin
Takaoka, Alyson
Hoad, Neala
Hancock, Jennifer
McMullen, Sarah
Reeve, Brenda
Dechert, William
Smith, Orla M.
Sandhu, Gyan
Lockington, Julie
Cook, Deborah J.
author_facet Vanstone, Meredith
Neville, Thanh H.
Swinton, Marilyn E.
Sadik, Marina
Clarke, France J.
LeBlanc, Allana
Tam, Benjamin
Takaoka, Alyson
Hoad, Neala
Hancock, Jennifer
McMullen, Sarah
Reeve, Brenda
Dechert, William
Smith, Orla M.
Sandhu, Gyan
Lockington, Julie
Cook, Deborah J.
author_sort Vanstone, Meredith
collection PubMed
description BACKGROUND: The 3 Wishes Project (3WP) is an end-of-life program that honors the dignity of dying patients by fostering meaningful connections among patients, families, and clinicians. Since 2013, it has become embedded in the culture of end-of-life care in over 20 ICUs across North America. The purpose of the current study is to describe the variation in implementation of 3WP across sites, in order to ascertain which factors facilitated multicenter implementation, which factors remain consistent across sites, and which may be adapted to suit local needs. METHODS: Using the methodology of qualitative description, we collected interview and focus group data from 85 clinicians who participated in the successful initiation and sustainment of 3WP in 9 ICUs. We describe the transition between different models of 3WP implementation, from core clinical program to the incorporation of various research activities. We describe various sources of financial and in-kind resources accessed to support the program. RESULTS: Beyond sharing a common goal of improving end-of-life care, sites varied considerably in organizational context, staff complement, and resources. Despite these differences, the program was successfully implemented at each site and eventually evolved from a clinical or research intervention to a general approach to end-of-life care. Key to this success was flexibility and the empowerment of frontline staff to tailor the program to address identified needs with available resources. This adaptability was fueled by cross-pollination of ideas within and outside of each site, resulting in the establishment of a network of like-minded individuals with a shared purpose. CONCLUSIONS: The successful initiation and sustainment of 3WP relied on local adaptations to suit organizational needs and resources. The semi-structured nature of the program facilitated these adaptations, encouraged creative and important ways of relating within local clinical cultures, and reinforced the main tenet of the program: meaningful human connection at the end of life. Local adaptations also encouraged a team approach to care, supplementing the typical patient-clinician dyad by explicitly empowering the healthcare team to collectively recognize and respond to the needs of dying patients, families, and each other. TRIAL REGISTRATION: NCT04147169, retrospectively registered with clinicaltrials.gov on October 31, 2019.
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spelling pubmed-73256462020-07-01 Expanding the 3 Wishes Project for compassionate end-of-life care: a qualitative evaluation of local adaptations Vanstone, Meredith Neville, Thanh H. Swinton, Marilyn E. Sadik, Marina Clarke, France J. LeBlanc, Allana Tam, Benjamin Takaoka, Alyson Hoad, Neala Hancock, Jennifer McMullen, Sarah Reeve, Brenda Dechert, William Smith, Orla M. Sandhu, Gyan Lockington, Julie Cook, Deborah J. BMC Palliat Care Research Article BACKGROUND: The 3 Wishes Project (3WP) is an end-of-life program that honors the dignity of dying patients by fostering meaningful connections among patients, families, and clinicians. Since 2013, it has become embedded in the culture of end-of-life care in over 20 ICUs across North America. The purpose of the current study is to describe the variation in implementation of 3WP across sites, in order to ascertain which factors facilitated multicenter implementation, which factors remain consistent across sites, and which may be adapted to suit local needs. METHODS: Using the methodology of qualitative description, we collected interview and focus group data from 85 clinicians who participated in the successful initiation and sustainment of 3WP in 9 ICUs. We describe the transition between different models of 3WP implementation, from core clinical program to the incorporation of various research activities. We describe various sources of financial and in-kind resources accessed to support the program. RESULTS: Beyond sharing a common goal of improving end-of-life care, sites varied considerably in organizational context, staff complement, and resources. Despite these differences, the program was successfully implemented at each site and eventually evolved from a clinical or research intervention to a general approach to end-of-life care. Key to this success was flexibility and the empowerment of frontline staff to tailor the program to address identified needs with available resources. This adaptability was fueled by cross-pollination of ideas within and outside of each site, resulting in the establishment of a network of like-minded individuals with a shared purpose. CONCLUSIONS: The successful initiation and sustainment of 3WP relied on local adaptations to suit organizational needs and resources. The semi-structured nature of the program facilitated these adaptations, encouraged creative and important ways of relating within local clinical cultures, and reinforced the main tenet of the program: meaningful human connection at the end of life. Local adaptations also encouraged a team approach to care, supplementing the typical patient-clinician dyad by explicitly empowering the healthcare team to collectively recognize and respond to the needs of dying patients, families, and each other. TRIAL REGISTRATION: NCT04147169, retrospectively registered with clinicaltrials.gov on October 31, 2019. BioMed Central 2020-06-30 /pmc/articles/PMC7325646/ /pubmed/32605623 http://dx.doi.org/10.1186/s12904-020-00601-5 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Vanstone, Meredith
Neville, Thanh H.
Swinton, Marilyn E.
Sadik, Marina
Clarke, France J.
LeBlanc, Allana
Tam, Benjamin
Takaoka, Alyson
Hoad, Neala
Hancock, Jennifer
McMullen, Sarah
Reeve, Brenda
Dechert, William
Smith, Orla M.
Sandhu, Gyan
Lockington, Julie
Cook, Deborah J.
Expanding the 3 Wishes Project for compassionate end-of-life care: a qualitative evaluation of local adaptations
title Expanding the 3 Wishes Project for compassionate end-of-life care: a qualitative evaluation of local adaptations
title_full Expanding the 3 Wishes Project for compassionate end-of-life care: a qualitative evaluation of local adaptations
title_fullStr Expanding the 3 Wishes Project for compassionate end-of-life care: a qualitative evaluation of local adaptations
title_full_unstemmed Expanding the 3 Wishes Project for compassionate end-of-life care: a qualitative evaluation of local adaptations
title_short Expanding the 3 Wishes Project for compassionate end-of-life care: a qualitative evaluation of local adaptations
title_sort expanding the 3 wishes project for compassionate end-of-life care: a qualitative evaluation of local adaptations
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7325646/
https://www.ncbi.nlm.nih.gov/pubmed/32605623
http://dx.doi.org/10.1186/s12904-020-00601-5
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