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

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.

Study Overview

• Status: Completed
• Conditions: Death; End of Life
• Intervention / Treatment: Other: 3 Wishes Program (3WP)

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 Type: Observational
• Enrollment (Actual): 314

Contacts and Locations

Study Locations

• United States
  • California
    • Los Angeles, California, United States, 90095
      • Ronald Reagan UCLA Medical Center
    • Santa Monica, California, United States, 90404
      • UCLA Santa Monica Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 21 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Patients who died in the adult ICU and their families

Description

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 Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
3WP; Patients who had 3WP as part of their end-of-life care	Other: 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.
Usual Care; Patients who did not have 3WP as part of their end-of-life care

What is the study measuring?

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

Collaborators and Investigators

• Sponsor: University of California, Los Angeles

Publications and helpful links

General Publications

• 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.
• 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.
• 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.
• 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.

Study record dates

Study Major Dates

• Study Start (Actual): October 8, 2019
• Primary Completion (Actual): July 4, 2021
• Study Completion (Actual): November 9, 2021

Study Registration Dates

• First Submitted: November 10, 2021
• First Submitted That Met QC Criteria: November 10, 2021
• First Posted (Actual): November 22, 2021

Study Record Updates

• Last Update Posted (Actual): December 2, 2021
• Last Update Submitted That Met QC Criteria: November 20, 2021
• Last Verified: November 1, 2021

More Information

Terms related to this study

• Keywords: palliative care; intensive care unit; end of life
• Additional Relevant MeSH Terms: Pathologic Processes; Death
• Other Study ID Numbers: Effect of 3WP on BFS

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No