Death, End of Life
Conditions
Keywords
end of life, palliative care, intensive care unit
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.
Interventions
OTHER3 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.
Sponsors
University of California, Los Angeles
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
21 Years to No maximum
Healthy volunteers
No
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Emotional and Spiritual Support | 3 months after the patient's death | Emotional and spiritual support factor score on the Bereaved Family Survey total score ranges 0-9 (higher is better) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Bereaved Family Survey Performance Measure | 3 months after the patient's death | overall assessment of quality of end of life care 0-1 (higher is better) |
Countries
United States
Outcome results
None listed