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

Enter the text here that is the new abstract information for your application. This section must be no longer than 30 lines of text. 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. These public hospitals operate under significant budgetary constraints while serving patients with limited or no health insurance. Despite the critical importance of high-quality EOL care, its delivery is often complicated by communication difficulties and differing expectations between families and medical teams. EOL experiences in intensive care units (ICUs) can lead to significant emotional strain for family members. Palliative care interventions are needed, but implementation is frequently limited by operational and financial constraints. 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 hospitals with limited operational capacities. We believe that this innovative program can improve the EOL experience in SNHs, although it must be adapted to the contextual differences and needs of low-resource hospitals. We 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, we will implement and evaluate the 3WP in the three SNHs within the Los Angeles County Department of Health Services. We 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. We will use the Consolidated Framework for Implementation Research (CFIR) and the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to guide a mixed-methods evaluation of the 3WP implementation in SNHs. Our research team brings expertise in EOL care, clinical implementation, and research in public hospital systems. We anticipate that this evaluation will provide practical insights for applying innovative EOL interventions in public hospitals facing resource constraints. The findings may serve as a guide for wider application of the 3WP across a variety of hospital environments.