科研之友
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摘要
Background: The quality of end-of-life (EOL) care at Veterans Affairs Medical Centers (VAMC) has improved. To date, however, the quality and outcomes of end-of-life care delivered to women veterans have not been examined. Objective: The goal of this study was to evaluate gender differences in the quality of EOL care received by patients in VAMCs nationwide. Design: The study was conducted via retrospective medical chart review and telephone survey with next of kin of recently deceased inpatients. Setting/subjects: The chart review included records for all patients who died in acute and long-term care units in 145 VAMCs nationwide (n = 36,618). For the survey, the documented next of kin were invited to respond on behalf of the deceased veteran; a total of 25,638 next of kin completed the survey. Measurements: Chart review measures included five indicators of optimal end-of-life care. Bereaved family survey items included one global and nine specific items (e. g., bereavement care, pain management) describing care in the last month of life. Results: Receipt of optimal end-of-life care did not differ significantly between women and men with respect to frequency of discussion of treatment goals with a family member, receipt of palliative consult, bereavement contact, and chaplain contact with a family member. Family members of women were more likely than those of men to report that the overall care provided to the veteran had been "excellent" (adjusted proportions: 63% versus 56%; odds ratio (OR) = 1.33; 95% confidence interval (CI) 1.10-1.61; p = 0.003). Conclusions: In this nationwide study of all inpatient deaths in VAMCs, women received comparable and on some metrics better quality EOL care than that received by male patients.
- 出版日期2013-7
