Families' perceptions of end-of-life care in Veterans Affairs versus non-Veterans Affairs facilities

J Palliat Med. 2010 Aug;13(8):991-6. doi: 10.1089/jpm.2010.0044.


Background: The Veterans Affairs (VA) has made significant investments in care for veterans. However, it is not known whether these investments have produced improvements in end-of-life care in the VA compared to other settings. Therefore, the goal of this study was to compare families' perceptions of end-of-life care among patients who died in VA and non-VA facilities.

Design: Retrospective 32-item telephone surveys were conducted with family members of patients who died in VA and non-VA facilities.

Setting: Five Veterans Affairs medical centers and their affiliated nursing homes and outpatient clinics.

Participants: Patients were eligible if they received any care from a participating VA facility in the last month of life and if they died in an inpatient setting. One family member per patient completed the survey.

Results: In bivariate analysis, patients who died in VA facilities (n = 520) had higher mean satisfaction scores compared to those who died in non-VA facilities (n = 89; 59 versus 51; rank sum test p = 0.002). After adjusting for medical center, the overall score was still significantly higher for those dying in the VA (beta = 0.07; confidence interval [CI] = 0.02-0.11; p = 0.004), as was the domain measuring care around the time of death (beta = 0.11; CI = 0.04-0.17; p = 0.001).

Conclusion: Families of patients who died in VA facilities rated care as being better than did families of those who died in non-VA facilities. These results provide preliminary evidence that the VA's investment in end-of-life care has contributed to improvements in care in VA facilities compared to non-VA facilities.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Attitude to Health*
  • Communication
  • Family / psychology*
  • Female
  • Health Care Surveys
  • Health Services Accessibility / organization & administration
  • Hospitals, Veterans / organization & administration*
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Quality of Health Care / organization & administration
  • Regression Analysis
  • Retrospective Studies
  • Social Support
  • Spirituality
  • Statistics, Nonparametric
  • Surveys and Questionnaires
  • Terminal Care / organization & administration*
  • United States
  • United States Department of Veterans Affairs
  • Veterans* / statistics & numerical data