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

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society Pub Date : 2024-07-06 DOI:10.1111/jgs.19050

Cari Levy MD, PhD, Aryan Esmaeili MD, PhD, Dawn Smith MS, Robert V. Hogikyan MD, MPH, Vyjeyanthi S. Periyakoil MD, Joan G. Carpenter PhD, CRNP, Anne Sales PhD, RN, Ciaran S. Phibbs PhD, Andrew Murray BS, Mary Ersek PhD, RN, FPCN

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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.

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退伍军人事务部疗养院中退伍军人死者临终护理的维持生命治疗决定和家属评估。

背景：退伍军人健康管理局（VA）以 "维持生命治疗医嘱 "计划为蓝本，实施了 "维持生命治疗（LST）决定倡议"，旨在通过规范重病退伍军人的LST偏好文件来改善临终结局。本研究调查了退伍军人管理局疗养院中退伍军人生命最后一个月的生命维持治疗文件和家属对护理评估之间的关联：对 2018 年 7 月 1 日至 2020 年 1 月 31 日期间退伍军人疗养院中死者的数据进行回顾性横截面分析（N = 14575）。回归建模生成主要临终结局和家属对护理质量评价的几率：12928名（89%）退伍军人疗养院死者记录了LST偏好。与我们的假设相反，在调整后的分析中，接受想要的药物和医疗治疗（调整后的几率比 [OR]：0.85，95% 置信区间 [CI]：0.63, 1.16）和生命最后一个月对整体护理的评价（调整后的几率比 [OR]：0.96，95% 置信区间 [CI]：0.76, 1.22）在有完成 LST 模板和没有完成 LST 模板的患者之间没有显著差异：结论：在社区生活中心（CLC）的死者中，89%的人记录了LST偏好。有和没有 LST 偏好记录的退伍军人的家属对护理的评价没有明显差异。旨在改善社区生活中心家属对临终关怀质量评价的干预措施不应脱离与家属对临终关怀质量评价较高相关的其他因素而孤立地以LST记录为目标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.