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.

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.

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

Patients who died in the adult ICU and their families