Personalized End of Life Care in Safety-Net Hospitals: Implementation of the 3 Wishes Project
试验速览
- 阶段
- 不适用
- 状态
- 进行中（未招募）
- 入组人数
- 900
- 试验地点
- 8
- 主要终点
- Families' assessment of the quality of end-of-life, particularly in emotional and spiritual support.
研究概览
简要总结
Dignified and compassionate end-of-life (EOL) care is a cornerstone of high-quality, patient-centered care, but in safety-net hospitals EOL care is often overlooked, considered too late, or not at all. By eliciting and implementing final wishes for dying patients, the 3 Wishes Project (3WP) has demonstrated, in tertiary academic centers, that acts of compassion can improve the EOL experience and help families cope with loss. The investigators propose to implement the 3WP in safety-net hospitals where there are less resources and more diverse, disadvantaged patient populations, and hypothesize that there will be similar positive effects on the EOL experience for patients, families, and clinicians.
详细描述
Compassionate end-of-life (EOL) care is foundational to medicine, but providing patients and families in safety-net hospitals (SNHs) with the sense that they are physically and emotionally supported during a patient's terminal hospitalization can be challenging. SNHs are public hospitals that primarily provide services to low-income and uninsured patients on a minimal budget. Although high quality EOL care is an important unmet need in SNHs, its provision is fraught with barriers and challenges. Language barriers, low health literacy, and cultural differences can make it difficult for families in SNHs to perceive empathy and support during the EOL. Deaths in the intensive care unit (ICU) for underserved families can be traumatic, and families of patients who die in the ICU often suffer from depression and post-traumatic stress disorder. Palliative care interventions are needed, but implementation is often resource-prohibitive.
The 3 Wishes Project (3WP) is a palliative care intervention that aims to achieve a dignified and compassionate EOL experience by empowering the clinical team to elicit and fulfill small wishes for critically ill patients who are dying in the ICU. Although the 3WP has been shown to improve a family's experience of their loved one's EOL care, ease bereavement, and enhance clinician work satisfaction in academic centers, it has not been implemented and evaluated in low-resource hospitals. The investigators believe that this patient-centered and clinician-partnered initiative can improve the EOL experience in SNHs, but that it must be adapted to the contextual differences and needs of low-resource hospitals.
Investigators propose to obtain and use stakeholder input to customize a multi-component 3WP Toolkit that will facilitate 3WP implementation in SNHs. Using the tailored Toolkit, the investigators will implement and evaluate the 3WP in the three SNHs of the Los Angeles County Department of Health Services. The investigators will conduct a pragmatic type 2 hybrid effectiveness-implementation study to evaluate the quality of EOL ICU care, bereaved families' psychological symptoms, and clinician burnout as compared to usual care. The Consolidated Framework for Implementation Research (CFIR) and the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework will be used to guide a mixed-methods evaluation of the 3WP implementation in SNHs.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Supportive Care
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •For participation in the 3WP, if there was a decision to withdraw life support or the health care team agreed that the patient's probability of dying in the hospital or on discharge to hospice was >95% For surveys, next of kin/surrogate of a patient who died in the ICU during the study period For surveys, speaks English or Spanish
排除标准
- •<18 years old
- •does not speak english or spanish
研究组 & 干预措施
3WP intervention
families of patients whose loved ones died in the ICU where the 3 Wishes Program has been implemented
干预措施: 3 Wishes Project (Other)
结局指标
主要结局
Families' assessment of the quality of end-of-life, particularly in emotional and spiritual support.
时间窗: 3 months after patient's death (families will be surveyed 3 months after the date of death).
Bereaved families of patients who died in the ICU will complete an after-death survey, which includes the Bereaved Family Survey (BFS). The BFS asks questions regarding the family's perception of the patient's end of life care. We will also use a question from the FS-ICU (family satisfaction with ICU) to assess whether family felt supported in final hours of patient's life.
Families' assessment of the quality of end-of-life, particularly in emotional and spiritual support.
时间窗: 3 months after patient's death (families will be surveyed 3 months after the date of death).
Bereaved families of patients who died in the ICU will complete an after-death survey, which includes the Bereaved Family Survey (BFS). The BFS asks questions regarding the family's perception of the patient's end of life care. We will also use a question from the FS-ICU (family satisfaction with ICU) to assess whether family felt supported in final hours of patient's life.
次要结局
- Nurse Burnout(6 months and 1 year after)
- Family anxiety and depression(3 months after patient's death (families will be surveyed 3 months after the date of death).)
- Family PTSD(3 months after patient's death (families will be surveyed 3 months after the date of death).)
研究者
Thanh H. Neville, MD, MSHS
Associate Professor
University of California, Los Angeles