• Meredith Vanstone, Thanh H Neville, France J Clarke, Marilyn Swinton, Marina Sadik, Alyson Takaoka, Orla Smith, Andrew J Baker, Allana LeBlanc, Denise Foster, Vinay Dhingra, Peter Phung, Xueqing Sherry Xu, Yuhan Kao, Diane Heels-Ansdell, Benjamin Tam, Feli Toledo, Anne Boyle, and Deborah J Cook.
• McMaster University, Hamilton, Ontario, Canada (M.V., F.J.C., M.S., M.S., A.T., D.H.).
• Ann. Intern. Med. 2020 Jan 7; 172 (1): 1-11.

BackgroundThe 3 Wishes Project (3WP) is an end-of-life program that aims to honor the dignity of dying patients by creating meaningful patient- and family-centered memories while promoting humanistic interprofessional care.ObjectiveTo determine whether this palliative intervention could be successfully implemented-defined as demonstrating value, transferability, affordability, and sustainability-beyond the intensive care unit in which it was created.DesignMixed-methods formative program evaluation. (ClinicalTrials.gov: NCT04147169).Setting4 North American intensive care units.ParticipantsDying patients, their families, clinicians, hospital managers, and administrators.InterventionWishes from dying patients, family members, and clinicians were elicited and implemented.MeasurementsPatient characteristics and processes of care; the number, type, and cost of each wish; and semistructured interviews and focus groups with family members, clinicians, and managers.ResultsA total of 730 patients were enrolled, and 3407 wishes were elicited. Qualitative data were gathered from 75 family members, 72 clinicians, and 20 managers or hospital administrators. Value included intentional comforting of families as they honored the lives and legacies of their loved ones while inspiring compassionate clinical care. Factors promoting transferability included family appreciation and a collaborative intensive care unit culture committed to dignity-conserving end-of-life care. Staff participation evolved from passive support to professional agency. Program initiation required minimal investment for reusable materials; thereafter, the mean cost was $5.19 (SD, $17.14) per wish. Sustainability was demonstrated by the continuation of 3WP at each site after study completion.LimitationThis descriptive formative evaluation describes tertiary care center-specific experiences rather than aiming for generalizability to all jurisdictions.ConclusionThe 3WP is a transferrable, affordable, and sustainable program that provides value to dying patients, their families, clinicians, and institutions.Primary Funding SourceGreenwall Foundation.

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