Engaging youth in end-of-life care: The 3 Wishes Project experience

Background Citizen engagement can create a community of compassion for dying hospitalized patients. Objectives To describe a family co-designed end-of-life intervention engaging schoolchildren, and characterize dying hospitalized patients and their terminal wishes. Methods This cohort study partnered a healthcare organization and educational institution to voluntarily engage students attending senior, middle, junior, and Montessori schools in an end-of-life care program. The 3 Wishes Project involved hospital staff and family members eliciting and implementing wishes to honor dying patients. Age-appropriate engagement involved student-led acts of compassion. Data were analyzed using descriptive statistics. Results From June 2024–May 2026, 481 patients were enrolled, aged 65.4 (16.8) [mean (standard deviation)] years. The most common diagnoses were neurologic or neurosurgical (175, 36.4%), cardiovascular or vascular (97, 20.2%) and trauma (59, 12.3%). Of 2305 elicited end-of-life wishes, 2280 (98.9%) were implemented. Personnel eliciting wishes included nurses (169, 35.1%), social workers (152, 31.6%) and the project coordinator (99, 20.6%). Common wishes were tributes and keepsakes (820, 35.6%), acts to humanize the patient (374, 16.2%) and facilitating connections (248, 10.8%). The project coordinator as a child life specialist offered bereavement resources for children with dying hospitalized relatives, coached families and staff on sensitive communication about death and grief, and liased with the school. Students engaged in this end-of-life program for 125 (26.0%) of decedents, participating in 162 (7.1%) wishes by creating compassion cards, lavender sachets, crochet hearts and personalized memory boxes. Conclusions Community engagement in this adaptation of the 3 Wishes Project involved family member co-design and student partnership to help with terminal wishes for dying hospitalized patients.