Evidence map›Paper›PMID 38970392›Full record

ArticleJournal of the American Geriatrics Society2024

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

Cari Levy, Aryan Esmaeili, Dawn Smith, Robert V Hogikyan, Vyjeyanthi S Periyakoil, Joan G Carpenter, Anne Sales, Ciaran S Phibbs, Andrew Murray, Mary Ersek

Abstract read
In one paragraph

Article in Journal of the American Geriatrics Society, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Cari LevyDepartment of Veterans Affairs, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA.ORCID 0000-0002-7485-280X
Aryan EsmaeiliDepartment of Veterans Affairs, Palo Alto, California, USA.
Dawn SmithVeteran Experience Center, Department of Veterans Affairs, Philadelphia, Pennsylvania, USA.
Robert V HogikyanDepartment of Veterans Affairs, Ann Arbor VA Medical Center, Ann Arbor, Michigan, USA.
Vyjeyanthi S PeriyakoilDepartment of Veterans Affairs, Palo Alto, California, USA.
Joan G CarpenterDepartment of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland, USA.ORCID 0000-0002-8039-9466
Anne SalesDepartment of Veterans Affairs, Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan, USA.
Ciaran S PhibbsDepartment of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, California, USA.
Andrew MurrayDepartment of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.ORCID 0000-0002-7211-896X
Mary ErsekVeteran Experience Center, Department of Veterans Affairs, Philadelphia, Pennsylvania, USA.ORCID 0000-0002-0520-311X

Funding

HSRD VA I50 HX003177Quality Enhancement Research Initiative P30AG059307Quality Enhancement Research Initiative QUE 15-288Quality Enhancement Research Initiative R01AG062239Quality Enhancement Research Initiative U54MD012495
6 · The paper itself

Abstract

backgroundModeled 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.

methodsRetrospective, 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.

resultsLST 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.

conclusionsAmong 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.

Indexed as

Nursing HomesTerminal CareUnited States Department of Veterans AffairsVeteransAgedAged, 80 and overCross-Sectional StudiesDecision MakingFamilyFemaleHumansLife Support CareMaleRetrospective StudiesUnited Statesadvance directivesbereavementgoals of carenursing homeveteran

Identifiers

PMID38970392
PMCPMC13271830

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.