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June 12, 2018

Ronald Reagan UCLA Medical Center honors dying patients by granting 3 wishes

Daily Briefing

    Ronald Reagan UCLA Medical Center in December launched the 3 Wishes Project, a palliative care program that aims to honor the lives of terminally ill patients and help families cope and find closure, Maria Castellucci reports for Modern Healthcare.

    Download URMC's question prompt list to start improving end-of-life care for patients

    How it works

    Under the program, UCLA offers to fulfill three wishes for patients who are terminally ill. Clinicians approach a patient about the program if the patient's chance of death during their time in the ICU is 95% or higher, Castellucci reports. If the patient is unconscious, clinicians ask the family how they would like to see their loved one honored.

    According to Castellucci, UCLA is thought to be the first hospital in the United States to offer the program, which began at a Canadian hospital in 2013.

    A group of ICU doctors and nurses make up a team that tells patients and their families about the program. They introduce the program using a script created by Thanh Neville, a UCLA critical-care physician and Peter Phung, a palliative care physician.

    Neville said that similar conversations about creating meaning at the end of life were already happening in the ICU at UCLA before the program launched, but the formal program provides funding to actually grant wishes. UCLA implemented the program with a $10,000 grant from the California State University Institute for Palliative Care. The program also has received funding from philanthropists and family members of former patients, according to Castellucci.

    Many wishes are fairly inexpensive and easy to fulfill, Neville said. One patient, for example, wanted to spend his final moments in the oncology department, rather than in another area of the hospital,  because he felt more comfortable with the team there. That had "never been done before," Neville said, but it was granted through the 3 Wishes Program.

    Another patient, Christine Mathis, asked for potato chips, pictures of her family on the ICU walls, and to be flown back to her home in Las Vegas to die. According to Ambre Schaffer, Mathis' granddaughter, although the trip back to Las Vegas wasn't funded by the 3 Wishes Program, "without their involvement and really pushing and uniting doctors together to make it happen, I don't think she would've been able to pass at home."

    'They definitely changed the entire experience'

    So far, 46 patients have participated in the 3 Wishes Program

    Neville, who is interviewing family members to research the program's impact and usefulness, said, "100% of the people I've interviewed so far have told me it made a huge impact on their loved ones' dying process, and they can walk around with a positive memory."

    The program helps staff cope, too, Neville said, as losing a patient can be hard on them as well.

    Schaffer said that the program helped her cope with the loss of her grandmother. "It was a big relationship, and I knew my entire life that losing her would be very hard," she said. "I don't know how I would've done it without [the UCLA staff]" (Castellucci, Modern Healthcare, 6/2).

    Next, get URMC's end-of-life conversation prompts

    When it comes to end-of-life care, most organizations struggle to meet patients' needs. In a recent poll, 87% of Americans age 65 and older said that they believe their doctor should discuss end-of-life issues with their patients; however, only 27% of those polled had actually discussed these issues with their doctor.

    Download URMC's conversation prompts to start improving end-of-life care for patients.

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