Clinical trial NCT05128799: Effect of the 3 Wishes Program on Bereaved Families' End-of-Life Care Perceptions
Official title: Effect of the 3 Wishes Program on Bereaved Families' End-of-Life Care Perceptions
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: End of Life
Death
Keywords: end of life
palliative care
intensive care unit
Lead sponsor: University of California, Los Angeles
Sponsor class: OTHER
First posted: 2021-11-22
Enrollment: 314
Sex: ALL
Minimum age (years): 21
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: CASE_CONTROL
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Patients who died in the adult ICU and their families

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.

Eligibility criteria: 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

Primary outcomes:
measure: Emotional and Spiritual Support
timeFrame: 3 months after the patient's death
Secondary outcomes:
measure: Bereaved Family Survey Performance Measure
timeFrame: 3 months after the patient's death
Other outcomes:
Locations:
city: Los Angeles
country: United States
facility: Ronald Reagan UCLA Medical Center
state: California
city: Santa Monica
country: United States
facility: UCLA Santa Monica Medical Center
state: California
Study officials:
References:
citation: Vanstone M, Neville TH, Clarke FJ, Swinton M, Sadik M, Takaoka A, Smith O, Baker AJ, LeBlanc A, Foster D, Dhingra V, Phung P, Xu XS, Kao Y, Heels-Ansdell D, Tam B, Toledo F, Boyle A, Cook DJ. Compassionate End-of-Life Care: Mixed-Methods Multisite Evaluation of the 3 Wishes Project. Ann Intern Med. 2020 Jan 7;172(1):1-11. doi: 10.7326/M19-2438. Epub 2019 Nov 12.
citation: Neville TH, Bear DK, Kao Y, Xu XS, Hjelmhaug K, Quebral D, Sanaee N, Hainje J, Arriola G, Granone MC, White E, Chaturvedi A, Yu S, Clarke F, Cook DJ. End-of-Life Care During the Coronavirus Disease 2019 Pandemic: The 3 Wishes Program. Crit Care Explor. 2021 Oct 8;3(10):e549. doi: 10.1097/CCE.0000000000000549. eCollection 2021 Oct.
citation: Vanstone M, Sadik M, Smith O, Neville TH, LeBlanc A, Boyle A, Clarke FJ, Swinton ME, Takaoka A, Toledo F, Baker AJ, Phung P, Cook DJ. Building organizational compassion among teams delivering end-of-life care in the intensive care unit: The 3 Wishes Project. Palliat Med. 2020 Oct;34(9):1263-1273. doi: 10.1177/0269216320929538. Epub 2020 Jun 10.
citation: Neville TH, Clarke F, Takaoka A, Sadik M, Vanstone M, Phung P, Hjelmhaug K, Hainje J, Smith OM, LeBlanc A, Hoad N, Tam B, Reeve B, Cook DJ. Keepsakes at the End of Life. J Pain Symptom Manage. 2020 Nov;60(5):941-947. doi: 10.1016/j.jpainsymman.2020.06.011. Epub 2020 Jun 21.