View article

Most patients will lose decision-making capacity at the end of life. Little is known about the quality of care received by patients who have family involved in their care.

To evaluate differences in the receipt of quality end-of-life care for patients who died with and without family involvement.

We retrospectively reviewed the charts of 34,290 decedents from 146 acute and long-term care Veterans Affairs facilities between 2010 and 2011. Outcomes included: 1) palliative care consult, 2) chaplain visit, and 3) death in an inpatient hospice or palliative care unit. We also assessed “do not resuscitate” (DNR) orders. Family involvement was defined as documented discussions with the health care team in the last month of life. We used logistic regression adjusted for demographics, comorbidity, and clustered by facility. For chaplain visit, hospice or palliative care unit death, and DNR, we additionally …