Effect of the 3 Wishes Program on Bereaved Families' End-of-Life Care Perceptions

Completed

• Conditions: End of Life; Death
• Interventions: Other: 3 Wishes Program (3WP)

• Registration Number: NCT05128799
• Lead Sponsor: University of California, Los Angeles

Brief Summary

Dying in the intensive care unit (ICU) can be a source of trauma for patients and their families. The 3 Wishes Program is a palliative care initiative in which healthcare workers fulfills small wishes to provide a personalized, humanizing experience at the end of life (EOL) for dying patient and their families. The investigators' objective is to assess families' ratings of EOL care for ICU decedents who received the 3WP as part of their EOL care versus usual care.

Detailed Description

This is a quality improvement study to evaluate the effect of the 3 Wishes Program (3WP) on end-of-life (EOL) care in the adult ICUs of a two-hospital academic healthcare system.

At this health system, patients were invited to participate in the 3WP once a decision to withdraw life support was made or the health care team agreed that the patient's probability of dying in the hospital or on discharge to hospice was \>95%. As a quality improvement measure, 3WP initiation was up to the discretion of the clinical team. Patients and/or families provide verbal consent. HCWs, mostly nurses, asked how they might bring comfort to a dying patient and their family in the final hours or days of life. Wishes can also be suggested by the clinical team.

A modified Bereaved Family Survey (BFS), a cover letter and a self-addressed stamped envelope were mailed to the next of kin three months after the patient's death. Surveys had no identifying information and were tracked using a unique code. No incentive was offered. Two weeks following the initial mailing, non-responders received up to three telephone calls (at least one attempt after 5PM and maximum two voice messages) to request the return of the survey or to complete it by telephone, if preferred.

BFS results were compared between patients who received the 3WP and those who did not. Demographics and clinical characteristics were abstracted and included in multivariate models.

Study Timeline

• Study Start: 2019-10-08
• Primary Completion: 2021-07-04
• Status Verified: 2021-11
• Study Completion: 2021-11-09
• Study First Submitted: 2021-11-10
• Study First Submitted QC: 2021-11-10
• Last Update Submitted: 2021-11-20
• Study First Posted: 2021-11-22
• Last Update Posted: 2021-12-02

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 314

Inclusion Criteria

• 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

Exclusion Criteria

• <21 years old
• does not speak English

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
3WP	3 Wishes Program (3WP)	Patients who had 3WP as part of their end-of-life care

Primary Outcome Measures

Name	Time	Method
Emotional and Spiritual Support	3 months after the patient's death	Emotional and spiritual support factor score on the Bereaved Family Survey total score ranges 0-9 (higher is better)

Secondary Outcome Measures

Name	Time	Method
Bereaved Family Survey Performance Measure	3 months after the patient's death	overall assessment of quality of end of life care 0-1 (higher is better)

Trial Locations

Locations (2)

UCLA Santa Monica Medical Center; 🇺🇸 Santa Monica, California, United States

Ronald Reagan UCLA Medical Center; 🇺🇸 Los Angeles, California, United States