1. Life-sustaining treatment decisions and family evaluations of end-of-life care for Veteran decedents in Department of Veterans Affairs nursing homes.
- Author
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Levy C, Esmaeili A, Smith D, Hogikyan RV, Periyakoil VS, Carpenter JG, Sales A, Phibbs CS, Murray A, and Ersek M
- Subjects
- Humans, Male, United States, Female, Retrospective Studies, Cross-Sectional Studies, Aged, Aged, 80 and over, Family psychology, Life Support Care statistics & numerical data, Decision Making, Terminal Care statistics & numerical data, Nursing Homes statistics & numerical data, Veterans statistics & numerical data, Veterans psychology, United States Department of Veterans Affairs
- Abstract
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.)
- Published
- 2024
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