161: Pandemic Visiting Restrictions at the End of Life: Clinicians’ Experiences With the 3 Wishes Project

INTRODUCTION: Restricted visiting hours during the COVID-19 pandemic are common We hypothesized that clinicians would be distressed caring for patients at the end of life (EOL) related to visiting restrictions, as assessed in our pandemic-specific study to evaluate whether the 3 Wishes Project is feasible and valuable for dying patients METHODS: In an embedded mixed-methods study from March16-July 1, 2020, we enrolled patients with a ≥95% probability of death or plans to withdraw life support Clinicians and families elicited and implemented ≥3 final wishes/patient We recorded patient characteristics and clinician demographics We purposively sampled clinicians who cared for these patients for interviews 2-10 weeks postmortem;transcripts were analyzed using a qualitative descriptive approach RESULTS: For 45 enrolled patients, 236 wishes were elicited Overall, 5 2 (2 1) [mean (SD)] wishes/patient were implemented;50 (21%) by families Most patients (32, 71%) had family visits during their hospital stay (in the patient's room, outside the room, or at the outdoor window) At the time of death, a family member was present with 20 (44%) patients We interviewed 45 diverse clinicians with 13 7 (11 5) years of experience Clinicians discussed operationally challenging dimensions of visiting restrictions related to the timing, duration, number, and purpose of visitors;different policies across units;variable implementation of the same policy;and policies shifting during the pandemic Clinicians experienced moral distress caused by limited family companionship for patients Emotions evoked included heartbreak, concern, devastation, frustration, and helplessness This prompted professional coping strategies such as peer support;story-telling;informal debriefing;family advocacy;initiating research on this issue;and more intentional acts of compassion by creating meaningful wishes to personalize EOL care without family presence CONCLUSIONS: Clinicians experienced both first-hand and vicarious distress when caring for dying patients during the pandemic related to visiting restrictions The 3 Wishes Project provided a framework for empowering clinicians to provide humanistic EOL care for patients who were separated from their families