#32 Three Wishes with Dr. Thanh Neville
On this week’s episode of Critical Care Time, Nick & Cyrus have the honor of hosting Dr. Thanh Neville, MD, MSHS (X @thanh_neville) the director of the 3 Wishes Program out of UCLA. In this moving discussion we explore the importance of dying with dignity when curative intent is no longer a realistic option. We dovetail this with an impassioned exploration Dr. Neville’s incredible work with 3WP which relies on modest funding and the power of humanism to grant priceless gifts - Wishes, if you will - to dying patients and their loved ones in their 11th hour. Please give us a listen and let us know what you think!
Show Notes:
What is The Three Wishes Program?
The 3 Wishes Project (3WP) is a palliative care initiative that aims to improve the end-of-life experience for patients, families, and healthcare team members by working to fulfill wishes for a dying patient and their loved ones.
The 3WP provides individualized acts of kindness such as decorating the room, providing favorite foods, facilitating events such as birthday parties and weddings, and creating keepsakes.
These wishes have included complex events like weddings or bringing in a mariachi band.
By far the most common wish provided is keepsakes for the family. This can be a keychain containing a fingerprint, a lock of hair, an EKG strip, a recording of the patient’s heartbeat, or something that is more elaborate–such as a sculpture of a husband and wife holding hands for the final time.
The 3WP at UCLA was established by Dr Neville in 2017. Since then they have provided over 6800 wishes for dying patients and their loved ones.
The direct cost of doing 3WP for a dying patient and their family has been $32.
What are the benefits of 3WP?
The original description of a 3WP describing interviewed with families about the experience. Families reported improved Emotional and Spiritual Support scores on a BFS instrument.
The program has been successful in multiple hospitals and is transferable and sustainable.
One mixed methods study of 3WP implementation in 4 North American ICUs found that the costs were minimal (initiation required minimal investment for reusable materials; thereafter, the mean cost was $5.19 per wish), and sustainable (as demonstrated by the continuation of 3WP at each site after study completion.)
Providing keepsakes to family members is a low cost (median cost $8.50, interquartile range $2.00-$25.00) intervention that is highly valued by families and staff. Keepsakes were especially valued during the COVID pandemic, when ICU visitation was limited.
Dr. Neville also discusses the future of the program and her plans to expand it nationally and internationally.
Implementing a 3WP at your hospital
The program can be implemented in hospitals with different resources and settings, and there are resources available to help start and sustain the program.
Though pioneered in larger academic facilities, 3WP has been successfully implemented at smaller community hospitals.
Several resources exist for establishing 3WP at your hospital:
See the FAQ at threewishesproject.com for an overview and Startup Guide
You can request access to the 3WP Toolkit at UCLA (must be a health professional)
Audio
Video
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Vanstone M, Neville TH, Clarke F, et al. Compassionate End-of-Life Care: Mixed-methods multi-site evaluation of the 3 Wishes Project.Annals of Internal Medicine 2020
TH Neville, F Clarke, A Takaoka, M et al, Keepsakes at the End of Life. Journal of Pain and Symptom Management 2020
TH Neville, D Bear, Y Kao, et al, End-of-Life Care During the COVID-19 Pandemic: the 3 Wishes Program. Critical Care Explorations. 2021
TH Neville, Z Taich, AM Walling, D Bear, DJ Cook, C Tseng, NS Wenger. The 3 Wishes Program Improves Families’ Experience of Emotional and Spiritual Support at the End-Of-Life. Journal of General Internal Medicine., 2022
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