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

NCT ID: NCT05128799

Last Updated: 2021-12-02

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

314 participants

Study Classification

OBSERVATIONAL

Study Start Date

2019-10-08

Study Completion Date

2021-11-09

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.

Conditions

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End of Life Death

Keywords

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end of life palliative care intensive care unit

Study Design

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Observational Model Type

CASE_CONTROL

Study Time Perspective

PROSPECTIVE

Study Groups

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3WP

Patients who had 3WP as part of their end-of-life care

3 Wishes Program (3WP)

Intervention Type OTHER

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.

Usual Care

Patients who did not have 3WP as part of their end-of-life care

No interventions assigned to this group

Interventions

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3 Wishes Program (3WP)

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.

Intervention Type OTHER

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
Minimum Eligible Age

21 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of California, Los Angeles

OTHER

Sponsor Role lead

Responsible Party

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Thanh H. Neville, MD, MSHS

Associate Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Ronald Reagan UCLA Medical Center

Los Angeles, California, United States

Site Status

UCLA Santa Monica Medical Center

Santa Monica, California, United States

Site Status

Countries

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United States

References

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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.

Reference Type BACKGROUND
PMID: 31711111 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 34651136 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 32519615 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 32574658 (View on PubMed)

Other Identifiers

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Effect of 3WP on BFS

Identifier Type: -

Identifier Source: org_study_id