Really awesome the article published online last week in Annals of Intern Medicine: “Personalizing Death in the Intensive Care Unit: The 3 Wishes Project: A Mixed-Methods Study” by Dr. Deborah Cook and her team of McMaster University Health Sciences Center in Hamilton, Ontario.

The “3 wishes Project” wants to improve and dignify the process of death for ICU patients, allows to show through a research study conducted in an intensive care unit that there is always something more to do for our patients, especially those who already have no chance of recovery.
This project which included 40 patients with limitation of life-sustaining treatment or a possibility of dying greater than 95% at ICU, and invites patients and their families to formulate three wishes. Once formulated, intensive professionals try to satisfy them with the aim of improving the inevitable and the painful experience of dying in the ICU.

The wishes were classified in five categories: humanization of the patient (e.g., a date night in the ICU), personal tributes (e.g. providing a last meal for the family at the information room), family reconnect (die with all members of the family present), rituals (a commemorative ceremony beside the bed) and “help in advance” (organ donation).

The results show the effectiveness of the intervention to the carry out successfully 159 wishes of the 163 formulated, and all this at a cost between nothing and $200 per patient. It looks a lot like by so little… A highly cost effective intervention.

The study may be open to criticism from the scientific point of view, by its design and outcome measures used to evaluate the intervention.

It is not a study “before-after”, nor there is a control group. The wishes were mostly formulated by families (only 7% of the patients were able to participate in an active way) and it was not possible to demonstrate a real benefit on patients. But the interviews and questionnaires made to relatives of patients and professionals underscore the possibility of customize death through the voice of the family and fostering the compassion of healthc care workers of intensive.

Possibly some of the wishes had to be negotiated so that they were feasible, (not be contemplated to die at home even if it is a frequently expressed desire) and subjectivity in establishing the wishes were fulfilled and assess the effect of the same is evident.

In any case, a real example of the interest of intensive care team in humanizing heals, honoring, using the words of one participant, to the ” everyday heroes, those that go unnoticed but whose lives are important, putting face to processes without a face”, treating patients as individuals and dignified the death.

Finally this project enables professionals to offer more, when it seems that we can do nothing, rather than the powerlessness of having lost the battle.

Then, we could ask our patients: What can we do for you? How we can do this day the best for you?. Returns to put the patient at the centre of our attention and stimulates us to improve even more and until the end in the attention and care of our patients.

I don´t know how scientific is, but personally I find it a great project.

Dr. Mari Cruz Martin.
Head of Intensive Care Unit.
Hospital Universitario de Torrejón