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

April 21, 2026 updated by: Thanh H. Neville, MD, MSHS, University of California, Los Angeles

Personalized End of Life Care in Safety-Net Hospitals: Implementation of the 3 Wishes Project

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.

Study Overview

Status

Active, not recruiting

Conditions

Intervention / Treatment

Detailed Description

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.

Study Type

Interventional

Enrollment (Estimated)

900

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • California
      • Los Angeles, California, United States, 90095
        • Ronald Reagan UCLA Medical Center
      • Los Angeles, California, United States, 90033
        • LA General Hospital
      • Sylmar, California, United States, 91342
        • Olive View Medical Center
      • Torrance, California, United States, 90502
        • Harbor-UCLA

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

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 or Spanish

Exclusion Criteria:

  • <18 years old
  • does not speak english or spanish

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Supportive Care
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: 3WP intervention
families of patients whose loved ones died in the ICU where the 3 Wishes Program has been implemented
Other: 3 Wishes Project
palliative care initiative in which clinicians elicits and implements small acts of kindness for dying patients and their families

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Families' assessment of the quality of end-of-life, particularly in emotional and spiritual support.
Time Frame: 3 months after patient's death (families will be surveyed 3 months after the date of death).
Bereaved families of patients who died in the ICU will complete an after-death survey, which includes the Bereaved Family Survey (BFS). The BFS asks questions regarding the family's perception of the patient's end of life care. We will also use a question from the FS-ICU (family satisfaction with ICU) to assess whether family felt supported in final hours of patient's life.
3 months after patient's death (families will be surveyed 3 months after the date of death).

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Family anxiety and depression
Time Frame: 3 months after patient's death (families will be surveyed 3 months after the date of death).
The Hospital Anxiety and Depression scale (HADS) will part of the after death survey.
3 months after patient's death (families will be surveyed 3 months after the date of death).
Nurse Burnout
Time Frame: 6 months and 1 year after
Nurses will be asked to complete a survey (MBI) that evaluates nursing burnout before and after 3WP implementation.
6 months and 1 year after
Family PTSD
Time Frame: 3 months after patient's death (families will be surveyed 3 months after the date of death).
The PTSD Checklist for DSM-V (PCL-5) is part of the after death survey
3 months after patient's death (families will be surveyed 3 months after the date of death).

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of California, Los Angeles

Collaborators

National Institute of Nursing Research (NINR)
LAC+USC Medical Center
Olive View-UCLA Education & Research Institute

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

March 19, 2024

Primary Completion (Estimated)

August 1, 2028

Study Completion (Estimated)

August 1, 2028

Study Registration Dates

First Submitted

February 13, 2024

First Submitted That Met QC Criteria

February 21, 2024

First Posted (Actual)

February 26, 2024

Study Record Updates

Last Update Posted (Actual)

April 22, 2026

Last Update Submitted That Met QC Criteria

April 21, 2026

Last Verified

April 1, 2026

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 3WP in SNH
  • 5R01NR020773 (U.S. NIH Grant/Contract)

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

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Clinical Trials on End of Life

Clinical Trials on 3 Wishes Project

Search Similar Trials

Sponsors and Collaborators

Medical Conditions

Drug Interventions

CROs by country

CROs in Turkmenistan

Conditions

Rare Diseases

Drug Interventions

Dietary Supplements

Sponsor/Collaborators

Locations

Subscribe