As It Happens

'The simple things': Program that grants small wishes to dying patients deemed a success

The 3 Wishes Project, which began in Hamilton, Ont., is successful, powerful and cost-effective, according to a new study.

Study shows the 3 Wishes program is successful, powerful and cost-effective

Dr. Deborah Cook says many patients expressed that 'acts of kindness, these largely simple gestures, the encouragement of these meaningful activities at the bedside, and sometimes after the death, do bring comfort.' (Shaun Best/Reuters)


When there's little time left, it's the little things that matter most.

That's the message behind the 3 Wishes Project, a program that began in Hamilton, Ont., and later expanded to  Toronto, Vancouver and Los Angeles.  It operates in the intensive care unit of hospitals and grants small requests to dying patients and their families.

It comes at the worst times of people's lives. And yet, according to new research published in the Annals of Internal Medicine, the program has been successful, powerful and affordable.

"In the end, it's often the simple things that matter most," Dr. Deborah Cook, senior author of the study, told As It Happens guest host Helen Mann.

Cook is a critical care physician at St. Joseph's Healthcare Hamilton, where she launched the first 3 Wishes Project in 2013.

"Many of the wishes involve surrounding patients with the people and things that they love — their friends, their family, their pets, comforting music in the room, soft blankets, items from home," Cook said.

Cook is the senior author of the study. She's also a critical care physician at St. Joseph's Healthcare Hamilton, where she launched the 3 Wishes program in 2013. (McMaster University)

Cook says the program also helps assist patients in creating personal mementos for the loved ones they leave behind. 

"These are often cherished gifts," Cook said. "These are often held tight in the months or years to come. So that creativity has been nice to bring to the bedside."

Assessing the varying needs of a patient and their loved ones is a difficult and delicate act. But Cook says the study offers insights into how the 3 Wishes Project has helped caregivers and clinicians navigate end-of-life care with more compassion and confidence. 

"Part of our formative evaluation has been to talk to families [and] have them really tell us: Does this have any influence?" Cook said.

"They've expressed to us that these acts of kindness, these largely simple gestures, the encouragement of these meaningful activities at the bedside, and sometimes after the death, do bring comfort."

An impromptu performance and get-together in one patient’s room by family, friends and staff. (3 Wishes Project)

Over the course of the study, researchers interviewed families and caregivers of 730 terminally ill patients about their experiences with the program. Overall, 3,325 wishes were granted and, on average, wishes cost only $5.19 a piece.

The evaluation required a substantial grant from the the Greenwall Foundation and involved data gathering at care facilities in Hamilton, Toronto, Vancouver and Los Angeles.

But the program itself appeared sustainable, given the low cost of the wishes and the fact that the hospitals continued to offer the 3 Wishes Project even after the study year ended.

"[It] can be integrated into existing end-of-life programs," Cook said. "Over three quarters of the wishes have no cost to the program."

The researchers also interview clinicians. Cook says many of them said the project "meant a lot to them as practitioners and helped to make their own work more meaningful."

One patient's wish was to have the family dog at their bedside. (3 Wishes Project)

Rather than add more work to an already taxing and demanding job, the study showed even simple tasks like providing coffee or parking passes eased the daily stress of clinicians as well as the patients and their families.

"The data tells us that this is an important part of their job — reinvigorating, if you will, acts of compassion and kindness that surely are at the roots of why people go into healthcare," Cook said.

"I think it's been a reminder for all of us to reflect on what matters most."

Dr. Cook says the project has also given her pause in her own practice and strengthened her commitment to providing compassionate and creative ways to improve palliative care for everyone involved.

"The 3 Wishes Project has been a wonderful way to bring even more meaning to my career as a 30-year veteran in the intensive care unit," Cook said. "It's brought, I would say, joy at work."

Written by John McGill and Morgan Passi with files from Reuters. Interview with Dr. Deborah Cook produced by Morgan Passi.


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