The 3 Wishes Project (3WP) is an end-of-life program that honors the dignity of dying patients by fostering meaningful connections among patients, families, and clinicians. Since 2013, it has become embedded in the culture of end-of-life care in over 20 ICUs across North America. The purpose of the current study is to describe the variation in implementation of 3WP across sites, in order to ascertain which factors facilitated multicenter implementation, which factors remain consistent across sites, and which may be adapted to suit local needs. Using the methodology of qualitative description, we collected interview and focus group data from 85 clinicians who participated in the successful initiation and sustainment of 3WP in 9 ICUs. We describe the transition between different models of 3WP implementation, from core clinical program to the incorporation of various research activities. We describe various sources of financial and in-kind resources accessed to support the program. Beyond sharing a common goal of improving end-of-life care, sites varied considerably in organizational context, staff complement, and resources. Despite these differences, the program was successfully implemented at each site and eventually evolved from a clinical or research intervention to a general approach to end-of-life care. Key to this success was flexibility and the empowerment of frontline staff to tailor the program to address identified needs with available resources. This adaptability was fueled by cross-pollination of ideas within and outside of each site, resulting in the establishment of a network of like-minded individuals with a shared purpose. The successful initiation and sustainment of 3WP relied on local adaptations to suit organizational needs and resources. The semi-structured nature of the program facilitated these adaptations, encouraged creative and important ways of relating within local clinical cultures, and reinforced the main tenet of the program: meaningful human connection at the end of life. Local adaptations also encouraged a team approach to care, supplementing the typical patient-clinician dyad by explicitly empowering the healthcare team to collectively recognize and respond to the needs of dying patients, families, and each other. NCT04147169 , retrospectively registered with clinicaltrials.gov on October 31, 2019.

中文翻译：

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扩大“ 3个愿望”项目以提供富有同情心的临终关怀：对当地适应性的定性评估。

3个愿望项目（3WP）是一项生命终结计划，旨在通过在患者，家庭和临床医生之间建立有意义的联系来尊重垂死患者的尊严。自2013年以来，它已融入北美20多家ICU中的临终护理文化。当前研究的目的是描述不同站点之间3WP实施的差异，以确定哪些因素促进了多中心实施，哪些因素在站点之间保持一致，并且哪些因素可以适应当地需求。使用定性描述的方法，我们从参与9个ICU中成功启动和维持3WP的85位临床医生中收集了访谈和焦点小组数据。我们描述了3WP实施的不同模型之间的过渡，从核心临床计划到合并各种研究活动。我们描述了为支持该计划而获得的各种财务资源和实物资源。除了分享改善报废医疗的共同目标外，各场所的组织背景，人员补充和资源也相差很大。尽管存在这些差异，但该计划已在每个站点成功实施，并最终从临床或研究干预演变为临终护理的通用方法。成功的关键在于灵活性和一线员工的能力，以量身定制计划，以利用可用资源满足已确定的需求。每个站点内部和外部的思想交叉授粉推动了这种适应性的发展，从而建立了志趣相投的个人网络。3WP的成功启动和维持取决于当地的适应性发展，以适应组织的需求和资源。该计划的半结构化性质促进了这些适应，鼓励了在当地临床文化中建立联系的创新和重要方式，并强化了该计划的主要宗旨：生命尽头的有意义的人际关系。当地的适应措施还鼓励团队采用护理方法，通过明确授权医疗团队集体认识并响应垂死的患者，家人和彼此的需求，从而补充了典型的患者-临床医生的方法。NCT04147169，于2019年10月31日在临床试验网进行了追溯注册。该计划的半结构化性质促进了这些适应，鼓励了在当地临床文化中建立联系的创新和重要方式，并强化了该计划的主要宗旨：生命尽头的有意义的人际关系。当地的适应措施还鼓励团队采用护理方法，通过明确授权医疗团队集体认识并响应垂死的患者，家人和彼此的需求，从而补充了典型的患者-临床医生的方法。NCT04147169，于2019年10月31日在临床试验网进行了追溯注册。该计划的半结构化性质促进了这些适应，鼓励了在当地临床文化中建立联系的创新和重要方式，并强化了该计划的主要宗旨：生命尽头的有意义的人际关系。本地适应措施还鼓励团队采用护理方法，通过明确授权医疗团队集体认识并响应垂死的患者，家庭和彼此的需求，从而补充了典型的患者-临床医生的方法。NCT04147169，于2019年10月31日在临床试验网进行了追溯注册。通过明确授权医疗团队集体认识并响应垂死的患者，家庭和彼此的需求，对典型的患者-临床医生进行了补充。NCT04147169，于2019年10月31日在临床试验网进行了追溯注册。通过明确授权医疗团队集体认识并响应垂死的患者，家庭和彼此的需求，对典型的患者-临床医生进行补充。NCT04147169，于2019年10月31日在临床试验网进行了追溯注册。