Wishes to Improve Support and Humanity at End-of-life in Safety-net Hospitals

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

ACTIVE_NOT_RECRUITING

Clinical Phase

NA

Total Enrollment

900 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-03-19

Study Completion Date

2028-08-31

Brief Summary

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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.

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Detailed Description

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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.

Conditions

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End of Life

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

This is a before and after stepped wedge study design

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

NONE

Study Groups

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3WP intervention

families of patients whose loved ones died in the ICU where the 3 Wishes Program has been implemented

Group Type EXPERIMENTAL

3 Wishes Project

Intervention Type OTHER

palliative care initiative in which clinicians elicits and implements small acts of kindness for dying patients and their families

Interventions

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3 Wishes Project

palliative care initiative in which clinicians elicits and implements small acts of kindness for dying patients and their families

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 or Spanish