Observational studyJournal of general internal medicine2020
Life-Sustaining Treatment Decisions Initiative: Early Implementation Results of a National Veterans Affairs Program to Honor Veterans' Care Preferences.
Observational study in Journal of general internal medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
18 citing papers in PubMed.
- Temporal Trends, Setting, and Timing of Palliative and Hospice Care in COPD in the Veterans Health Administration, 2010-2020.CHEST pulmonary · 2025Article
- A pragmatic and ethical guide for addressing life-sustaining treatments in patients with suicidal thoughts or behaviors.Journal of hospital medicine · 2025Article
- The COVID-19 Pandemic and Goals-of-Care Conversations in Veterans Health Administration Clinics.JAMA network open · 2025Article
- Increasing goals of care conversations in primary care: Study protocol for a cluster randomized, pragmatic, sequential multiple assignment randomized trial.Contemporary clinical trials · 2024Article
- Evaluating feedback reports to support documentation of veterans' care preferences in home based primary care.BMC geriatrics · 2024Article
- High-Intensity Care for Nursing Home Residents with Severe Dementia Hospitalized at the End of Life: A Mixed Methods Study.Journal of the American Medical Directors Association · 2024Article
- What Clinicians and Researchers Should Know About the Evolving Field of Advance Care Planning: a Narrative Review.Journal of general internal medicine · 2024Review
- Disparities in Preoperative Goals of Care Documentation in Veterans.JAMA network open · 2023Article
- No Wrong Floor on the Elevator: A Vision for the VA as an Age-Friendly Health System.Federal practitioner : for the health care professionals of the VA, DoD, and PHS · 2023Article
- Patient Characteristics Associated With Occurrence of Preoperative Goals-of-Care Conversations.JAMA network open · 2023Article
- Article
- Evaluating implementation strategies to support documentation of veterans' care preferences.Health services research · 2022Article
- Preferences Elicited and Respected for Seriously Ill Veterans through Enhanced Decision-Making (PERSIVED): a protocol for an implementation study in the Veterans Health Administration.Implementation science communications · 2022Article
- Care processes and racial/ethnic differences in family reports of end-of-life care among Veterans: A mediation analysis.Journal of the American Geriatrics Society · 2022Article
- Applying the Tailored Implementation in Chronic Diseases framework to inform implementation of the Preferences Elicited and Respected for Seriously Ill Veterans through enhanced decision-making program in the United States Veterans Health Administration.Frontiers in health services · 2022Article
- Telecommunication for Advance Care Planning in Heart Failure.Cardiac failure review · 2022Review
- An Initiative to Improve 30-Day Readmission Rates Using a Transitions-of-Care Clinic Among a Mixed Urban and Rural Veteran Population.Journal of hospital medicine · 2021Article
- Discontinuation of Statins in Veterans Admitted to Nursing Homes near the End of Life.Journal of the American Geriatrics Society · 2020Article
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
backgroundOn July 1, 2018, the Veterans Health Administration (VA) National Center for Ethics in Health Care implemented the Life-Sustaining Treatment Decisions Initiative (LSTDI). Its goal is to identify, document, and honor LST decisions of seriously ill veterans. Providers document veterans' goals and decisions using a standardized LST template and order set.
objectiveEvaluate the first 7 months of LSTDI implementation and identify predictors of LST template completion.
designRetrospective observational study of clinical and administrative data. We identified all completed LST templates, defined as completion of four required template fields. Templates also include four non-required fields. Results were stratified by risk of hospitalization or death as estimated by the Care Assessment Need (CAN) score. SUBJECTS: All veterans with VA utilization between July 1, 2018, and January 31, 2019. MAIN MEASURES: Completed LST templates, goals and LST preferences, and predictors of documentation.
resultsLST templates were documented for 108,145 veterans, and 85% had one or more of the non-required fields completed in addition to the required fields. Approximately half documented a preference for cardiopulmonary resuscitation. Among those who documented specific goals, half wanted to improve or maintain function, independence, and quality of life while 28% had a goal of life prolongation irrespective of risk of hospitalization/death and 45% expressed a goal of comfort. Only 7% expressed a goal of being cured. Predictors of documentation included VA nursing home residence, older age, frailty, and comorbidity, while non-Caucasian race, rural residence, and receipt of care in a lower complexity medical center were predictive of no documentation.
conclusionsLST decisions were documented for veterans at high risk of hospitalization or death. While few expressed a preference for cure, half desire, cardiopulmonary resuscitation. Predictors of documentation were generally consistent with existing literature. Opportunities to reduce observed disparities exist by leveraging available VA resources and programs.
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