ArticleBMJ supportive & palliative care2025
Better end-of-life care in surgical patients: Veterans Affairs Bereaved Family Survey - a qualitative analysis.
Article in BMJ supportive & palliative care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundEnd-of-life care among surgical patients is largely understudied and far fewer studies examine such care from the family perspective. To identify potential opportunities for improvement, we explored responses of family members of veterans who died following surgery using the Veterans Affairs (VAs) Bereaved Family Survey (BFS).
methodsWe examined data from the BFS open-text responses to explore insights into surgical patient's end-of-life care. Data were analysed iteratively using qualitative content analysis and clustered into domains based on content.
resultsWe evaluated 936 open-text responses to the BFS for all decedents who underwent any high-risk surgical procedure across 124 VA medical centres from 2010 to 2019. This report focused on the following domains: patient needs, family/caregiver needs, clinical teams/personnel characteristics and facility/organisational characteristics. Key themes within patient needs included concerns about pain management, preservation of patient dignity and spiritual support. Within the family/caregiver domain, key themes included enhanced communication needs, assistance with logistics and displays of gratitude for the patient's military service. The clinical team's domain included the key themes of professionalism concerns and understaffing. Finally, key themes identified within the facility/organisation domain were the need for more robust support services and discomfort with the physical space.
conclusionsNarratives from the family perspective provide valuable insight into end-of-life care among surgical patients. Our data demonstrate the critical need for preserving patient dignity and improved communication, which emphasises family involvement and shared decision-making. In addition, hospital systems can optimise nurse-to-patient ratios and intentionally design physical spaces to help improve end-of-life care for surgical patients.
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