ArticleJournal of pain and symptom management2021
End-of-Life Care for Persons Under Guardianship.
Article in Journal of pain and symptom management, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 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.
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Who cites it
4 citing papers in PubMed.
- Impact of Legal Protection on Life-Support Interventions and 3-Month Mortality in the Intensive Care Unit: The Vulne-Rea Study.Healthcare (Basel, Switzerland) · 2026Article
- Prolonged Hospitalization and Adverse Events in Veterans Awaiting Guardianship: A Retrospective Cohort Analysis.Journal of general internal medicine · 2025Article
- Guardianship Before and Following Hospitalization.HEC forum : an interdisciplinary journal on hospitals' ethical and legal issues · 2023Article
- Factors Associated With Distress Related to Posttraumatic Stress Disorder at the End of Life Among U.S. Veterans.Journal of pain and symptom management · 2023Observational
Corrections and comments
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Authors and funding
10 authors.
Funding
Abstract
contextGuardians are surrogate decision makers appointed by a court when other health care decision-makers are unable, unwilling, or unavailable to make decisions. Prior studies suggest that persons under guardianship may experience delays in transitions of care.
objectivesTo compare quality of end-of-life care for persons under guardianship to a matched group on objective indicators and to identify narrative themes characterizing potential obstacles to quality end-of-life care.
methodsOne hundred sixty-seven persons under guardianship who died between 2003 and 2019 within the Veterans Healthcare Administration in Massachusetts and Connecticut matched on a 1:1 basis to persons without guardians. The groups were compared on treatment specialty at death, days of hospice and intensive care unit care, and receipt of palliative care consultation. Additionally, patient narratives for those under guardianship with extended lengths in intensive care unit were subjected to qualitative analysis.
resultsOverall, <1% were under guardianship. Within this sample of persons who died within the Veterans Health Administration, persons under guardianship were as likely as patients in the comparison group to receive palliative care consultation (odds ratio [CI] = 0.93 [.590-1.46], P = .359), but were more likely to have ethics consultation (odds ratio [CI] = 0.25 [0.66-0.92], P = .036) and have longer lengths of ICU admission (β = -.34, t = -2.70, P = .009). Qualitative findings suggest that issues related to family conflict, fluctuating medical course, and limitations in guardian authority may underlie extended lengths of stay.
conclusionGuardianship appears to be rare, and as a rule, those under guardianship have equal access to hospice and palliative care within Veterans Health Administration. Guardianship may be associated with health-care challenges in a small number of cases, and this may drive perceptions of adverse outcomes.
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