Implementation and evaluation of the 3 Wishes Project in safety-net hospitals: Protocol for a hybrid effectiveness-implementation study
Bibliographic record
Abstract
BACKGROUND: Palliative care interventions in the intensive care unit have been shown to improve communication and the quality of death and dying. However, few interventions have been implemented in safety-net hospitals (SNHs), which provide healthcare to low income and uninsured patients. The 3 Wishes Project (3WP) is a low-cost intervention that aims to enhance compassionate end-of-life (EOL) experiences by empowering the clinical team to elicit and fulfill small wishes for patients who are dying in the ICU. OBJECTIVE: To implement and evaluate the 3WP in three SNHs in Los Angeles. METHODS: We conduct a pragmatic cluster-randomized stepped wedge type 2 hybrid effectiveness-implementation study to implement and evaluate the effect of the 3WP (compared to usual care) on quality of EOL ICU care, bereaved families' psychological symptoms, and clinician burnout. Prior to implementation, interviews with stakeholders from each hospital will refine the implementation strategy. Starting 6-10 months prior to 3WP implementation at each site and continuing throughout the study, we will survey bereaved families once 3 months after each patient's death. Surveys will query: EOL care, anxiety, depression, and post-traumatic stress disorder (PTSD). Each SNH ICU starts the 3WP at a randomly assigned time that is staggered by 2 months. Nurses are surveyed on burnout before implementation, 6 months, and 12 months after 3WP implementation. Semi-structured interviews are conducted with 10-12 family members per SNH who received 3WP and 10-12 nurses per SNH a year after implementation. We will use the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to guide a mixed-methods evaluation of the 3WP implementation in SNHs. CONCLUSION: We hypothesize that it will be feasible to adapt and implement the 3WP in SNHs. We will evaluate how the 3WP improves EOL care in this setting and provide valuable insight regarding the adaptations necessary to tailor palliative care interventions for SNH ICUs. TRIAL REGISTRATION: ClinicalTrials.gov NCT06277310.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.108 | 0.063 |
| Meta-epidemiology (narrow) | 0.006 | 0.004 |
| Meta-epidemiology (broad) | 0.006 | 0.005 |
| Bibliometrics | 0.004 | 0.004 |
| Science and technology studies | 0.005 | 0.005 |
| Scholarly communication | 0.004 | 0.005 |
| Open science | 0.005 | 0.004 |
| Research integrity | 0.007 | 0.009 |
| Insufficient payload (model declined to judge) | 0.053 | 0.011 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".