By Ramy Sedhom, MD
Patients with advanced disease frequently hear a lot of bad news, and as treatment options diminish, are often told: “There’s not much more we can do for you.”
For these patients and their families, these words can be devastating, signaling that the end of life is near.
But while there may not be anything more medically that can be done, there are meaningful ways to help critically ill patients, families and caregivers during a patient’s final days of life.
At Penn Medicine Princeton Medical Center (PMC), the palliative care team has implemented the 3 Wishes Project, which celebrates life by fulfilling three small wishes, specific to each patient or family’s request.
End-of-Life Experience
Research has long shown that the end-of-life experience can have a profound effect on a patient’s final days and on the grief and bereavement process for those left behind.
A compassionate and personalized end-of-life experience can bring a sense of peace and closure to patients, helping to ease anxiety and fear. It can also help provide comfort and closure to loved ones and help with the healing process.
Additionally, when a loved one has a “good death” so to speak, family members are less likely to experience depression, post-traumatic stress disorder and prolonged grief.
Moreover, it can provide peace and comfort to the patient’s care team. Physicians, nurses and other providers are by nature helpers and dedicated to doing whatever they can for their patient, even when they’ve run out of medical options.
That’s where the 3 Wishes Project comes in.
About 3 Wishes
Many critically ill patients spend their last days in a medical setting that is unfamiliar to them and their family members. When a patient nears the end of life, that can also take a toll on clinicians, who experience the emotional and psychological impact of a patient’s death.
The 3 Wishes Project, which was born at a hospital in Canada and adopted at several hospitals across the United States, aims to improve the end-of-life experience for all involved — patients, families, and clinicians — by fulfilling small wishes for dying patients.
Wishes are often simple acts of compassion, which might include playing comforting music, sharing a taste of their favorite food, a visit from a family pet, or creating a lasting keepsake, such as a fingerprint or EKG (electrocardiography) readout, for loved ones left behind.
The goals of the project are threefold:
- To provide dignity to the patient and celebrate their life.
- To provide comfort and closure to families and create positive memories.
- To provide staff an opportunity to care for both the patient and the family during a difficult time and do something positive.
Part of Palliative Care
The 3 Wishes Project is part of the palliative care program at Princeton Medical Center.
Palliative care is comprehensive, specialized medical care that is focused on symptom relief. This type of care is holistic and can include the physical, psychological, emotional and spiritual needs associated with serious illness and chronic disease.
While palliative care does address end-of-life needs, it is much more. The focus of palliative care is to establish goals of care with the patient and improve quality of life for both them and their family.
Palliative care involves an interdisciplinary team of physicians, including the patient’s specialists and primary care doctor, a palliative care physician, nurses and others. Together, the team develops an individualized plan to manage the patient’s unique symptoms and address how the disease impacts caregivers.
Palliative care can be provided at any point and can be delivered concurrently with any medical treatment a patient may receive. It can include:
- Management of emotional and physical symptoms, including complex pain, anxiety and depression, through prescription medication or non-pharmacological interventions.
- Emotional and spiritual support services to help address mental health needs.
- Coping strategies related to the disease, its treatment and side effects.
- Help with advance care planning and clear communication about what to expect in the future. This can help guide the patient in understanding and sharing their personal preferences regarding their medical care and priorities.
- Referrals to other support services that may benefit the patient.
- Legacy building, which helps the patient celebrate their life by sharing their story. For example, a patient might be encouraged to create a scrapbook or photo album to highlight past experience or memories that can be shared with others.
- Support for the patient’s caregivers and family, and bereavement care.
Multiple clinical trials have shown that patients with serious illness who received palliative care had equal or better symptom control and less anxiety and depression than patients who did not.
Referral for a palliative care consultation can be made by the patient’s doctor, other medical professional, or a patient can reach out on their own for an evaluation. Palliative care is covered by Medicare and Medicaid, as well as most other insurance providers.
Patients may receive palliative care in the hospital, in an outpatient setting, a long-term care facility, or at home under the direction of a licensed health care provider.
The final days of life can be difficult for patients, their families and their caregivers. Palliative care and the 3 Wishes Project at PMC can help offer comfort and peace, allowing patients to die with dignity and supporting the healing process for those left behind.
To schedule a palliative care consultation or learn more about the 3 Wishes Project, call (609) 853.6793.
Ramy Sedhom, MD, is a board-certified oncologist and palliative care physician. He is the Medical Director of Oncology and Palliative Care Penn Medicine Princeton Health and Assistant Professor of Clinical Medicine in the Perelman School of Medicine at the University of Pennsylvania.
