Life-sustaining treatment decisions and family evaluations of end-of-life care for Veteran decedents in Department of Veterans Affairs nursing homes.

Autor: Levy C; Department of Veterans Affairs, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA.; Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA., Esmaeili A; Department of Veterans Affairs, Palo Alto, California, USA., Smith D; Veteran Experience Center, Department of Veterans Affairs, Philadelphia, Pennsylvania, USA., Hogikyan RV; Department of Veterans Affairs, Ann Arbor VA Medical Center, Ann Arbor, Michigan, USA.; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA., Periyakoil VS; Department of Veterans Affairs, Palo Alto, California, USA., Carpenter JG; Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland, USA., Sales A; Department of Veterans Affairs, Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan, USA.; Sinclair School of Nursing and Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, USA., Phibbs CS; Department of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, California, USA.; Health Economics Resource Center (HERC), VA Palo Alto Health Care System, Menlo Park, California, USA., Murray A; Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.; Center for Health Equity Research and Promotion, Department of Veterans Affairs, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA., Ersek M; Veteran Experience Center, Department of Veterans Affairs, Philadelphia, Pennsylvania, USA.; Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.; Center for Health Equity Research and Promotion, Department of Veterans Affairs, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.
Jazyk: angličtina
Zdroj: Journal of the American Geriatrics Society [J Am Geriatr Soc] 2024 Sep; Vol. 72 (9), pp. 2709-2720. Date of Electronic Publication: 2024 Jul 06.
DOI: 10.1111/jgs.19050
Abstrakt: Background: Modeled after the Physician Orders for Life Sustaining Treatment program, the Veterans Health Administration (VA) implemented the Life-Sustaining Treatment (LST) Decisions Initiative to improve end-of-life outcomes by standardizing LST preference documentation for seriously ill Veterans. This study examined the associations between LST documentation and family evaluation of care in the final month of life for Veterans in VA nursing homes.
Methods: Retrospective, cross-sectional analysis of data for decedents in VA nursing homes between July 1, 2018 and January 31, 2020 (N = 14,575). Regression modeling generated odds for key end-of-life outcomes and family ratings of care quality.
Results: LST preferences were documented for 12,928 (89%) of VA nursing home decedents. Contrary to our hypothesis, neither receipt of wanted medications and medical treatment (adjusted odds ratio [OR]: 0.85, 95% confidence interval [CI] 0.63, 1.16) nor ratings of overall care in the last month of life (adjusted OR: 0.96, 95% CI 0.76, 1.22) differed significantly between those with and without completed LST templates in adjusted analyses.
Conclusions: Among Community Living Center (CLC) decedents, 89% had documented LST preferences. No significant differences were observed in family ratings of care between Veterans with and without documentation of LST preferences. Interventions aimed at improving family ratings of end-of-life care quality in CLCs should not target LST documentation in isolation of other factors associated with higher family ratings of end-of-life care quality.
(Published 2024. This article is a U.S. Government work and is in the public domain in the USA.)
Databáze: MEDLINE
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