Having a loved one or a patient die in a hospital’s intensive care unit is painful and stressful to families and caregivers.
UCLA’s Westwood ICU is the first in the U.S. to initiate a pilot research program to make the dying process more personal and dignified for patients and families. It is based on a similar program in Canada.
The 3 Wishes Project made one man’s end of life a little less painful for his wife.
Adam and Sandy Levitt loved the outdoors.
“He was always like, if it’s sunny out here, we have no excuse to be lazy, so we were always going for hikes, biking, walking down by the beach,” Sandy said.
They married in 2015. He’d suffered from an autoimmune condition for years. Last year, he got an infection and went into the ICU.
When it was clear Adam wasn’t going home, an ICU team moved Adam and the equipment that was keeping him alive to the terrace.
“I handed Sandy a blanket and she crawled into bed with Adam and we disconnected him from the ventilator. He was able to peacefully pass,” Dr. Thanh Neville said.
“Adam and I loved walking down to the beach and watching the sunsets together," Sandy said. "So, the fact that we could enjoy one last sunset together was … meant a lot to me.”
Sandy told Neville she still sleeps with that blanket because it’s the last thing Adam touched.
The 3 Wishes team has blankets, frames, pictures – all kinds of things to help patients and families with end of life.
“I feel privileged and honored that for the very first time that doctors and nurses are really able to do something very active in a patient’s and family’s darkest, darkest moment,” Neville said.
Neville is gauging the impact of 3 Wishes on families like sandy and ICU staff. Responses have been overwhelmingly positive.
Neville says they’ve filled wishes like creating a last date night, filling a patient room with memorabilia from Hawaii and bringing in a harpist to play classical music. They’ve fulfilled more than 400 wishes for 100 patients at an average cost of $30.
The project has already expanded to UCLA Santa Monica. Neville hopes other hospital systems all over the country adopt the program.
THREE LAST WISHES
BACKGROUND: A study was conducted from the University of Florida in 2016 about the level of comfort medical residents have with certain end-of-life care. It was found that residents received an inadequate amount of formal education on comfort-care and end-of-life care. In the study, 61.9% of residents reported that their end-of-life conversations were "mostly unsupervised" or "never supervised", giving them very little guidance about how to do better in the future. Research is also being studied with regard to the role of Speech-Language Pathologists (SLPs) working in palliative and end-of-life care. Speech-Language Pathologists have been recognized as having an important role among adult and pediatric populations though only recently has research begun to formalize this process. Nurses also play an extremely important role in comfort-care at the end-of-life. Nurses are able to explain in practical terms what is happening to the patient after the doctor has left. Nurses also work to advocate for the patients, as they spend a lot of time with them and typically know a great deal more about the patient's wishes, symptoms, and previous medical history. Nurses, doctors, and hospice workers are critical in helping both the patient and the family move through the death process, as well as the grief that follows after.
3 WISHES PROJECT: The 3 Wishes Project aims to improve the end-of-life experience in the intensive care unit by fulfilling small wishes for dying patients. “We try to elicit and implement wishes that make the dying process more individualized and dignified,” said Dr. Thanh Neville, an assistant professor in the division of pulmonary and critical care in the David Geffen School of Medicine at UCLA. “And, by honoring the patient’s life and creating a positive memory, we can help support family during an extremely difficult time.” Neville and Dr. Peter Phung, a palliative care physician at UCLA, launched the program after receiving a $10,000 grant from the California State University Institute for Palliative Care. Since its inception in December 2017, the project has granted the wishes of more than 40 people. Once it is accepted that death is imminent, the person has a greater than 95 percent chance of dying in the intensive care unit or there are already plans to remove life support in anticipation of death, the ICU team introduces the 3 Wishes Project as a way to honor the person in the dying process. Some examples of wishes are: arranging a final “date night”, planting a tree in the patient’s honor, or even making a clay hand casting of a couple holding hands for the last time.
PALLIATIVE CARE BREAKTHROUGH: As terminally ill patients move closer to death, palliative care specialists can help alleviate some of the pain patients may be experiencing. They can help patients have hard conversations about their medical treatments and options moving forward with their families and care teams. They can also soothe symptoms as they become more aggressive. “We often see the sickest of the sick. Once we are called, usually things are pretty bad at that point,” Purvi Patel, M.D., assistant clinical professor, Division of Palliative Care Medicine, Department of Supportive Care Medicine at City of Hope in California, said. “Oncologists and hematologists are naturally very skilled at having tough end-of-life conversations; it’s the nature of what they do every day. But we are here to provide additional support, especially if the transition to end-of-life care seems like it’s going to be particularly difficult,” continued Patel. Palliative care is a patient-centered discipline that seeks to improve the patient’s life, not just physically, but mentally and emotionally. Having this type of support can help patients retain their dignity while facing debilitating diagnoses.