UCLA end-of-life care program offers meaningful experience despite COVID-19 challenges

A program offered by the University of California, Los Angeles (UCLA) Health’s intensive care units providing meaningful and compassionate support for dying patients and their families is the first to show empirically that a palliative care program could be adapted and expanded during the novel coronavirus (COVID-19) pandemic, according to a new study published in the journal Critical Care Explorations.

For the study, researchers analyzed the number and types of wishes granted before and during the pandemic through UCLA Health’s 3 Wishes Program, which fulfills small but meaningful requests from dying patients and their families. The study followed 523 patients in six adult intensive care units at two locations, the Ronald Reagan UCLA Medical Center and the UCLA Santa Monica Medical Center.

Through the program, which was introduced in 2017, UCLA Health staff have presented patients and their families with mementos including keychains capturing the dying patient’s fingerprints, framed prints of electrocardiograms and sculptures of entwined hands of loved ones. They have arranged outdoor weddings and personal music performances, and commissioned volunteers to create paintings that honor patients’ interests and hobbies.

The research found that, despite the challenges of the pandemic, an average of 24.8 patients per month participated in the program during the period from March 1, 2020 through March 31, 2021, up from 17.6 patients per month during the same period a year earlier. Patients who died at the UCLA medical centers during the pandemic were less likely than those who died prior to the pandemic to have family with them and, the study found, more likely to have their postmortem wishes fulfilled for their families.

Through the program, patients’ requests are fulfilled not by palliative care specialists, but by frontline nurses, licensed vocational nurses, and physicians in the intensive care unit.  The program’s value became even more obvious during the pandemic, the study said, when spiritual care providers and social workers were only able to visit with patients online, and while hospital policies governing patients’ visits with family members have been in flux. At some points during the study period, no visits at all were allowed, while at others, family members were permitted only to visit when patients were near death and then, only for an hour at a time.

To keep the program going during the pandemic, hospital staff modified the way they fulfilled patients’ requests. For example, serenades took place outdoors to allow for physical distancing, and fingerprints used to make mementos were sterilized first with UV irradiation.  

The study could serve, the experts said, as a case study for improving end-of-life care during an era when visiting restrictions and infection control have introduced extraordinary new challenges for healthcare providers.