The 3 Wishes Project

The 3 Wishes Project (3WP) was founded in the Intensive Care Unit at St. Joseph’s Healthcare in 2013, with the overall goal of improving the quality of the dying experience for patients and their families. Led by Dr. Deborah Cook, this team of critical care researchers and interdisciplinary clinicians intentionally initiated conversations to learn more holistically about what is important and meaningful for dying patients and their families.

“I was inspired to try to honour the inherent dignity of each patient, call forth clinician compassion, and ease family grief,” says Dr. Cook.

In response to the growing interest from clinicians in other organizations, the research team developed a free start-up guide to help implement the program at other institutions. They collaborated by gathering data and sharing knowledge about caring more humanely for dying patients. Now, a decade later, the 3 Wishes Project continues to gain momentum across North America and around the world.

By asking about what matters most at the end of life and implementing personalized final wishes, the 3 Wishes Project encourages those involved to hone their listening skills, and recognize each individual holistically. One way to do this is to try to create some simple but often meaningful memories at the end of life.

Common wishes include mementos, comforting colourful blankets, bringing in personal items from home, and music – whether it’s listening to a patient’s favourite song or even live musicians. Family rituals, religious and other special ceremonies are also created. Several patients or their family members have exchanged memorable wedding vows at the bedside or the hospital chapel.

Through quantitative and qualitative research, including several hundred interviews with families, clinicians, and hospital leaders, the 3 Wishes Project team has found that this low tech, low risk, and low cost approach not only improved the end of life experience for patients and families, but also enhanced staff morale and reflected hospital values.

Since its inception, the 3WP has been adopted and adapted in numerous ICUs around the world and has been the topic of international graduate and post-doctoral work. To date, 26 manuscripts have been published about this personalized end of life intervention.

In 2017, UCLA pulmonologist Dr. Thanh Neville and palliative care physician Dr. Peter Phung co-founded the 3WP at UCLA Medical Center. According to Dr. Neville, some of the most common wishes that patients and families asked for were related to favourite food and beverages. One of her patients asked for congee (rice porridge), and to her surprise she couldn’t find any, so she went home and made it herself that evening.

The COVID-19 pandemic put an incredible strain on healthcare systems around the world. Necessary infection control measures restricted visiting hours and created barriers to human touch. Concerns were raised about whether there would be enough time or resources for the 3 Wishes Project to continue when patients were often dying without the presence of their family.

At St. Joe’s, 3 Wishes Project Coordinator, France Clarke, encouraged the team to redouble efforts and continue the research, knowing that the connections made through compassionate end of life care would be more important than ever in the pandemic.

Recollecting that stressful time to an audience of clinicians, Dr. Cook paused for a moment and said, somberly, “We were ready.”

“Adaptations had to be made,” added Dr. Neville, speaking on the 3 Wishes Project at UCLA during the pandemic.

In fact, several institutions implemented the 3 Wishes Project for the first time during the pandemic when staff morale was at an all-time low, including a team from the United Kingdom who had learned about it in a podcast. With institutional support and a major donor, they soon launched the 3 Wishes Project at the William Harvey Hospital in Kent, which included a garden renovation for critically ill patients.

The boost to staff morale was a boon for clinicians caring for dying patients during some of the most challenging years of their careers. Through this dark period, St. Joe’s ICU nurse, Yulia Shevchenko, began polar plunges in Lake Ontario at sunrise to help relieve stress and raise awareness about the importance of compassion in healthcare. Shevchenko pledged 333 plunges into the frigid waters of Lake Ontario in support of the 3 Wishes Project.

In 2023, the 3 Wishes Project celebrated its tenth year. The St. Joe’s team organized a two-day symposium on Compassionate Care, benefiting from the event planning experience of Laura Garrick from The Research Institute. Co-sponsored by McMaster University and the Gairdner Foundation, over 100 guests from across Canada, the US and the UK travelled to Hamilton to attend. This included physicians, nurses, respiratory therapists, physiotherapists, spiritual care staff, hospital leaders, trainees, and patients’ family members.

The informative and emotionally moving symposium involved attendees sharing their experience and insights about compassion. Each speaker brought unique views and new perspectives. Dr. Wes Ely from Vanderbilt University featured ways to integrate compassion into various aspects of practice. Other guests addressed the value of compassion in a learning healthcare system, special aspects of organ donation as a wish, and information about death and dying from the perspective of Indigenous and other cultures.

During each presentation, a unified theme resonated strongly throughout the symposium: amid tragedy and loss, acts of compassion are powerful, and have an indelible influence on patients, families and clinicians alike.

Learn more about the 3 Wishes Project by visiting their website.

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