3 Wishes Project improves end-of-life experience for patients and loved ones


Photo: Sherry Xu, MSN, RN, (left) and Thanh Neville, MD, MSHS

Although the medical intensive care unit (MICU) at Ronald Reagan UCLA Medical Center is designed to save lives, it’s also where some patients spend their final moments. “We see adult patients of all ages who succumb to a variety of medical conditions, such as cancer, respiratory infections, heart disease and organ failure,” says Sherry Xu, MSN, RN, MICU nursing director, Ronald Reagan UCLA Medical Center.

To improve the end-of-life experience for patients, loved ones and their care teams, the MICU introduced the 3 Wishes Project last December. “We elicit wishes from patients and their loved ones to celebrate and honor the lives of those who are dying, while supporting those who are grieving,” says Thanh Neville, MD, MSHS, a pulmonary and critical care physician who serves as the project’s principal investigator along with project leads Xu, Peter Phung, MD, MBA, palliative care physician, and Yuhan Kao, MSN, RN, clinical nurse specialist.

3 Wishes Project Team Members
From left: Peter Phung, MD, MBA, Neha Agarwal, MD, Donna Smith, RN, Thanh Neville, MD, MSHS, Sherry Xu, MSN, RN, Kristen Hjelmhaug, RN, and Jessica Hainje, RN.

During the project’s first three months, the MICU staff granted 102 wishes at an approximate cost of $35 per patient. Some wish requests don’t cost anything. “One patient wanted to spend his last moments outdoors. We were able to move his bed outside where he passed away with his wife by his side,” says Xu. “Some patients want to return to the unit where they spent much of their hospital time, such as oncology, so they can be surrounded by the nurses and doctors who cared for them for so long.”

Loved ones have asked for mementos, such as a lock of hair or a thumbprint keepsake. One popular request is a framed image called a word cloud. “Family members provide us with words that describe their loved one, such as mom, sister, brave, compassionate and creative,” says Dr. Neville. “We surround the patient’s name with these meaningful descriptive words to create a beautiful piece of art that can hang in the patient’s room and eventually go home with a loved one.”

Findings from McMaster University in Canada, where the program originated, suggest that this type of intervention can greatly improve the bereavement process for family members and bolster the morale of the health care team. “It can be extremely stressful to work in an environment where many patients unfortunately die,” says Dr. Neville. “The 3 Wishes Project helps the clinical staff find closure, too. It really provides 360 degrees of healing — for the patient, the family and the clinical team.”

The pilot program is currently funded by a grant from the California State University Institute for Palliative Care, and donations from VITAS Healthcare (a hospice and palliative services provider), the Katz Family Foundation and individual donors.

To measure the program’s efficacy, the project team members conduct ongoing surveys with clinical staff and interview family members of deceased patients. Depending on the findings and availability of additional funding, the team hopes to expand the project to other hospital units in Westwood and Santa Monica.