UCLA program aims to grant patients' wishes at the end of life

Ambre Schaffer was shocked when doctors at Ronald Reagan UCLA Medical Center said her grandmother had only a few days left to live.

Schaffer and her grandmother, Christine Mathis, were flown to UCLA in late February from a Las Vegas community hospital in search of answers after exhausting all options at that facility. Mathis seemed to be recovering well from a recent stroke, but her blood pressure took a sudden plunge, and the doctors in Las Vegas couldn't figure out why it wasn't returning to a normal level after two weeks in the intensive-care unit.

At UCLA, she was diagnosed with amyloidosis, a rare, and at that point fatal, liver disease. "It was a complete shock to me, to her. We knew she was deteriorating, but we didn't think it was something she couldn't come back from," Schaffer said. Devastated and overwhelmed by the news, Schaffer said a new program at UCLA, called the 3 Wishes Project, helped her cope and find closure in her grandmother's death.

The project, which UCLA launched last December, offers a way to dignify and celebrate a patient's life as they near death by fulfilling three of their wishes. Forty-six patients have gone through the program since it was launched.

UCLA is believed to be the first U.S. hospital to offer the program, created in 2013 by a Canadian hospital. UCLA used a $10,000 grant from the California State University Institute for Palliative Care to implement the program.

A group of ICU physicians and nurses were selected to be part of a team that introduces the 3 Wishes Project to patients and their family. Patients with a 95% or higher chance of dying during their ICU stay are approached about the program.

A script of what the clinicians can say to the patients and families was created by Dr. Thanh Neville, a UCLA critical-care physician who leads the program along with her colleague Dr. Peter Phung, a palliative-care physician.

The clinicians tell patients and families the project is a way to honor the patients' life. They then ask what UCLA can do to make the experience easier. If the patient is no longer conscious, family members are asked how they want to honor their loved ones. Sometimes nurses will even bring up the project to the patient and suggest wishes for them. "A lot of the conversations get initiated by the ICU bed nurse. They know the patient well," Neville said.

These conversations and actions were happening in the ICU before the 3 Wishes Project, but now, as it's a formal program, the staff has funding and can get support from other departments to make wishes come true, she said.

For instance, one patient wanted to spend his final moments on the oncology floor because he was more comfortable and closer to the team there. "That is something that has never been done before, but under the umbrella of 3 Wishes, I was able to explain to the oncology department that this is part of his three wishes and it would mean the world to him," Neville said.

The wishes are often inexpensive and doable, she added. Schaffer's grandmother asked for potato chips, pictures of her family on the ICU walls, and the support to be flown back to Las Vegas so she could die at home.

"3 Wishes didn't fund the trip home, but without their involvement and really pushing and uniting the doctors together to make it happen, I don't think she would've been able to pass at home," Schaffer said.

She said the 3 Wishes Project helped her cope with the pain of losing her grandmother, who raised her. "It was a big relationship, and I knew my entire life that losing her would be very hard. I don't know how I would've done it without them (the staff at UCLA). They definitely changed the entire experience."

Neville said it helps clinical staff cope, as well, since losing a patient can be hard on them.

Neville is conducting a research study to evaluate the program's impact and usefulness, and interviewing family members to gauge how beneficial it was for them. "100% of the people I've interviewed so far have told me it made a huge impact on their loved ones' dying process, and they can walk around with a positive memory," she said.

Philanthropists and former family members have also given money to keep the project going, with a $20,000 donation received a few months ago.