Alyson Takaoka1, Benjamin Tam2, Meredith Vanstone3, France J Clarke1, Neala Hoad4, Marilyn Swinton1, Feli Toledo5, Anne Boyle3,6, Anne Woods3,6, Erick H Duan2,4, Diane Heels-Ansdell1, Lily Waugh4, Mark Soth2,4, Jill Rudkowski2,4, Waleed Alhazzani1,2,4, Dan Perri2,4, Tania Ligori4,7, Roman Jaeschke2,4, Nicole Zytaruk1, Deborah J Cook8,9,10. 1. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada. 2. Department of Medicine, McMaster University, Hamilton, Ontario, Canada. 3. Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada. 4. Department of Critical Care Medicine, St Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada. 5. Department of Spiritual Care, St Joseph's Healthcare, Hamilton, Ontario, Canada. 6. Department of Palliative Care, St Joseph's Healthcare, Hamilton, Ontario, Canada. 7. Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada. 8. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada. debcook@mcmaster.ca. 9. Department of Medicine, McMaster University, Hamilton, Ontario, Canada. debcook@mcmaster.ca. 10. Department of Critical Care Medicine, St Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada. debcook@mcmaster.ca.
Abstract
BACKGROUND: Scaling-up and sustaining healthcare interventions can be challenging. Our objective was to describe how the 3 Wishes Project (3WP), a personalized end-of-life intervention, was scaled-up and sustained in an intensive care unit (ICU). METHODS: In a longitudinal mixed-methods study from January 12,013 - December 31, 2018, dying patients and families were invited to participate if the probability of patient death was > 95% or after a decision to withdraw life support. A research team member or bedside clinician learned more about each of the patients and their family, then elicited and implemented at least 3 personalized wishes for patients and/or family members. We used a qualitative descriptive approach to analyze interviews and focus groups conducted with 25 clinicians who cared for the enrolled patients. We used descriptive statistics to summarize patient, wish, and clinician characteristics, and analyzed outcome data in quarters using Statistical Process Control charts. The primary outcome was enrollment of terminally ill patients and respective families; the secondary outcome was the number of wishes per patient; tertiary outcomes included wish features and stakeholder involvement. RESULTS: Both qualitative and quantitative analyses suggested a three-phase approach to the scale-up of this intervention during which 369 dying patients were enrolled, having 2039 terminal wishes implemented. From a research project to clinical program to an approach to practice, we documented a three-fold increase in enrolment with a five-fold increase in total wishes implemented, without a change in cost. Beginning as a study, the protocol provided structure; starting gradually enabled frontline staff to experience and recognize the value of acts of compassion for patients, families, and clinicians. The transition to a clinical program was marked by handover from the research staff to bedside staff, whereby project catalysts mentored project champions to create staff partnerships, and family engagement became more intentional. The final transition involved empowering staff to integrate the program as an approach to care, expanding it within and beyond the organization. CONCLUSIONS: The 3WP is an end-of-life intervention which was implemented as a study, scaled-up into a clinical program, and sustained by becoming integrated into practice as an approach to care.
BACKGROUND: Scaling-up and sustaining healthcare interventions can be challenging. Our objective was to describe how the 3 Wishes Project (3WP), a personalized end-of-life intervention, was scaled-up and sustained in an intensive care unit (ICU). METHODS: In a longitudinal mixed-methods study from January 12,013 - December 31, 2018, dying patients and families were invited to participate if the probability of patientdeath was > 95% or after a decision to withdraw life support. A research team member or bedside clinician learned more about each of the patients and their family, then elicited and implemented at least 3 personalized wishes for patients and/or family members. We used a qualitative descriptive approach to analyze interviews and focus groups conducted with 25 clinicians who cared for the enrolled patients. We used descriptive statistics to summarize patient, wish, and clinician characteristics, and analyzed outcome data in quarters using Statistical Process Control charts. The primary outcome was enrollment of terminally ill patients and respective families; the secondary outcome was the number of wishes per patient; tertiary outcomes included wish features and stakeholder involvement. RESULTS: Both qualitative and quantitative analyses suggested a three-phase approach to the scale-up of this intervention during which 369 dying patients were enrolled, having 2039 terminal wishes implemented. From a research project to clinical program to an approach to practice, we documented a three-fold increase in enrolment with a five-fold increase in total wishes implemented, without a change in cost. Beginning as a study, the protocol provided structure; starting gradually enabled frontline staff to experience and recognize the value of acts of compassion for patients, families, and clinicians. The transition to a clinical program was marked by handover from the research staff to bedside staff, whereby project catalysts mentored project champions to create staff partnerships, and family engagement became more intentional. The final transition involved empowering staff to integrate the program as an approach to care, expanding it within and beyond the organization. CONCLUSIONS: The 3WP is an end-of-life intervention which was implemented as a study, scaled-up into a clinical program, and sustained by becoming integrated into practice as an approach to care.
Authors: Deborah Cook; Marilyn Swinton; Feli Toledo; France Clarke; Trudy Rose; Tracey Hand-Breckenridge; Anne Boyle; Anne Woods; Nicole Zytaruk; Diane Heels-Ansdell; Robert Sheppard Journal: Ann Intern Med Date: 2015-08-18 Impact factor: 25.391
Authors: Meredith Vanstone; Thanh H Neville; Marilyn E Swinton; Marina Sadik; France J Clarke; Allana LeBlanc; Benjamin Tam; Alyson Takaoka; Neala Hoad; Jennifer Hancock; Sarah McMullen; Brenda Reeve; William Dechert; Orla M Smith; Gyan Sandhu; Julie Lockington; Deborah J Cook Journal: BMC Palliat Care Date: 2020-06-30 Impact factor: 3.234
Authors: Brittany Dennis; Meredith Vanstone; Marilyn Swinton; Daniel Brandt Vegas; Joanna C Dionne; Andrew Cheung; France J Clarke; Neala Hoad; Anne Boyle; Jessica Huynh; Feli Toledo; Mark Soth; Thanh H Neville; Kirsten Fiest; Deborah J Cook Journal: BMJ Open Date: 2022-01-19 Impact factor: 2.692