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

NCT06277310 | Active Not Recruiting DMC

• 2 other identifiers: 3WP in SNH5R01NR020773
• Study Type: interventional
• Target: 900
• Locations: 1 country
• Sites: 4

Brief Summary

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.

Conditions

End of Life

Outcome Measures

Primary Outcomes (1)

• Families' assessment of the quality of end-of-life, particularly in emotional and spiritual support.

  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 Outcomes (3)

• Family anxiety and depression

  3 months after patient's death (families will be surveyed 3 months after the date of death).

• Nurse Burnout

  6 months and 1 year after

• Family PTSD

  3 months after patient's death (families will be surveyed 3 months after the date of death).

Study Arms (1)

3WP intervention

EXPERIMENTAL

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

Other: 3 Wishes Project

Interventions

3 Wishes Project OTHER

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

3WP intervention

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• 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

You may not qualify if:

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

Sponsors & Collaborators

• University of California, Los Angeles: lead
• Olive View-UCLA Education & Research Institute: collaborator
• LAC+USC Medical Center: collaborator
• National Institute of Nursing Research (NINR): collaborator

Study Sites (4)

LA General Hospital

Los Angeles, California, 90033, United States

Location

Ronald Reagan UCLA Medical Center

Los Angeles, California, 90095, United States

Location

Olive View Medical Center

Sylmar, California, 91342, United States

Location

Harbor-UCLA

Torrance, California, 90502, United States

Location

Related Publications (6)

• 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.

  PMID: 32574658 BACKGROUND

• 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.

  PMID: 31711111 BACKGROUND

• Vanstone M, Neville TH, Swinton ME, Sadik M, Clarke FJ, LeBlanc A, Tam B, Takaoka A, Hoad N, Hancock J, McMullen S, Reeve B, Dechert W, Smith OM, Sandhu G, Lockington J, Cook DJ. Expanding the 3 Wishes Project for compassionate end-of-life care: a qualitative evaluation of local adaptations. BMC Palliat Care. 2020 Jun 30;19(1):93. doi: 10.1186/s12904-020-00601-5.

  PMID: 32605623 BACKGROUND

• Cook DJ, Clarke FJ, Neville TH, Hoad N, Boyle A, Woods A, Dionne JC, Dennis BB, Toledo F, Tam B, Swinton M, Reid J, Vanstone M. The 3 Wishes Project: toward spiritual care at the end of life. Pol Arch Intern Med. 2023 Mar 29;133(3):16465. doi: 10.20452/pamw.16465. Epub 2023 Mar 29. No abstract available.

  PMID: 36994496 BACKGROUND

• Neville TH, Taich Z, Walling AM, Bear D, Cook DJ, Tseng CH, Wenger NS. The 3 Wishes Program Improves Families' Experience of Emotional and Spiritual Support at the End of Life. J Gen Intern Med. 2023 Jan;38(1):115-121. doi: 10.1007/s11606-022-07638-7. Epub 2022 May 17.

  PMID: 35581456 BACKGROUND

• Neville TH, Walling A, Wenger NS, Mittman BS, Tseng CH, Chang D, Cook D, Marentes Ruiz CJ, Cassano H, Beers E, Gadgil R, Kamangar N, Blake N, Tarn DM. Implementation and evaluation of the 3 Wishes Project in safety-net hospitals: Protocol for a hybrid effectiveness-implementation study. PLoS One. 2025 May 2;20(5):e0320843. doi: 10.1371/journal.pone.0320843. eCollection 2025.

  PMID: 40315279 DERIVED

MeSH Terms

Conditions

Death

Condition Hierarchy (Ancestors)

Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: SUPPORTIVE CARE
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor

Model Details: This is a before and after stepped wedge study design

Study Record Dates

• First Submitted: February 13, 2024
• First Posted: February 26, 2024
• Study Start: March 19, 2024
• Primary Completion (Estimated): August 1, 2028
• Study Completion (Estimated): August 1, 2028
• Last Updated: April 22, 2026

Record last verified: 2026-04

Data Sharing

• IPD Sharing: Will not share

Locations

US (4)