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

Study Overview
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Brief Summary
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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
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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.

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

Conditions
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End of Life, Death

Intervention / Treatment
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* Other: 3 Wishes Program (3WP)


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 21 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| 3WP<br>Patients who had 3WP as part of their end-of-life care | Other: 3 Wishes Program (3WP)<br>* The 3 Wishes Program (3WP) is a palliative care intervention in which small wishes are implemented by healthcare workers (HCWs) in an effort to improve the EOL experience for dying patients and their families. Examples of wishes include playing the patient's favorite music, providing a non-hospital blanket, orchestrating a final date night, decorating a patient's room to reflect their identify, and providing grieving family members with keepsakes such as thumbprint keychains, framed EKG mementos, or word clouds.<br>|
| Usual Care<br>Patients who did not have 3WP as part of their end-of-life care | |

What is the study measuring?
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Primary Outcome Measures

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

Secondary Outcome Measures

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

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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end of life, palliative care, intensive care unit