• Alyson Takaoka, Meredith Vanstone, Thanh H Neville, Sophia Goksoyr, Marilyn Swinton, France J Clarke, Orla M Smith, Allana LeBlanc, Denise Foster, Yuhan Kao, Xueqing Xu, Neala Hoad, Feli Toledo, and Deborah J Cook.
• Takaoka was a graduate student at the time the work was conducted, Marilyn Swinton is a research coordinator, and France J. Clarke is a respiratory therapist and research coordinator, Department of Health Research Methods, Evidence, and Impact, Meredith Vanstone is an associate professor, Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
• Am. J. Crit. Care. 2020 Nov 1; 29 (6): 422-428.

BackgroundA recent randomized trial of bereaved family members of patients who died in an intensive care unit identified symptoms of depression and posttraumatic stress in recipients of semistructured condolence letters.ObjectivesTo explore family member and clinician experiences with receiving or sending handwritten sympathy cards upon the death of patients involved in a personalized end-of-life intervention, the 3 Wishes Project.MethodsInterviews and focus groups were held with 171 family members and 222 clinicians at 4 centers to discuss their experiences with the 3 Wishes Project. Interview transcripts were searched to identify participants who discussed sympathy cards. Data related to sympathy cards were independently coded by 2 investigators through conventional content analysis.ResultsSympathy cards were discussed during 32 interviews (by 25 family members of 21 patients and by 11 clinicians) and 2 focus groups (8 other clinicians). Family members reported that personalized sympathy cards were a welcome surprise; they experienced them as a heartfelt act of compassion. Clinicians viewed cards as an opportunity to express shared humanity with families, reminding them that they and their loved one were not forgotten. Signing cards allowed clinicians to reminisce individually and collectively with colleagues. Family members and clinicians experienced sympathy cards as a meaningful continuation of care after a patient's death.ConclusionsInviting clinicians who cared for deceased patients to offer personalized, handwritten condolences to bereaved family members may cultivate sincere and individualized expressions of sympathy that bereaved families appreciate after the death of patients involved in the 3 Wishes Project.©2020 American Association of Critical-Care Nurses.

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