ArticleJournal of general internal medicine2025
Documentation of Life-Sustaining Treatment Preferences in a National Cohort of Veteran Decedents.
Article in Journal of general internal medicine, 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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10 authors.
Funding
Abstract
backgroundDiscussing and documenting preferences for life-sustaining treatment (LST) is critical for patient-centered care, yet many patients do not have documented plans when a medical crisis arises. In 2018, the Veterans Health Administration (VHA) introduced a standardized electronic health record (EHR) note to facilitate LST preference documentation for high-risk Veterans.
objectiveAssess patterns and factors associated with LST note completion.
designRetrospective cohort study. PATIENTS: National sample of 22,919 Veterans aged ≥ 60 years who died in 2021 and received VHA care in the 2 years before death. MAIN MEASURES: LST note completion was defined as having EHR documentation of all required note questions. We obtained Veteran sociodemographic, clinical, and care utilization factors over the 2 years before death using VHA and Medicare claims data. KEY
resultsOf the cohort, 6573 (28.7%) had an LST note documented ≥ 1 time. First LST documentation occurred a median of 362 days before death; a surrogate consented to 2209 (33.6%) of the most recent completions. Completion was markedly higher in those admitted to high-intensity VHA services (i.e., hospital, nursing home, or home-based primary care), so we estimated logistic regression models stratified by the presence (n = 8485) or absence (n = 14,434) of any high-intensity VHA care. In adjusted analyses of both strata, greater comorbidity, hospice use, and more primary care visits were associated with higher odds of LST note completion (p < 0.001). Among decedents without high-intensity VHA care, being unmarried with a child as next of kin and more VA financial benefits were also associated with higher odds of completion (p < 0.001).
conclusionsLST note completion occurred in a minority of decedents, was strongly tied to high-intensity VHA service utilization, and was often done by a surrogate. Opportunities may exist to improve documentation of patient preferences in outpatient settings farther in advance of health declines.
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