Journal article
Care processes and racial/ethnic differences in family reports of end-of-life care among Veterans: A mediation analysis
Journal of the American Geriatrics Society (JAGS), v 70(4), pp 1095-1105
Apr 2022
PMID: 34985133
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Bereaved family members of racial/ethnic minority Veterans are less likely than families of White Veterans to provide favorable overall ratings of end-of-life (EOL) care quality; however, the underlying mechanisms for these differences have not been explored. The objective of this study was to examine whether a set of EOL care process measures mediated the association between Veteran race/ethnicity and bereaved families' overall rating of the quality of EOL care in VA medical centers (VAMCs).
A retrospective, cross-sectional analysis of linked Bereaved Family Survey (BFS), administrative and clinical data was conducted. The sample included 17,911 Veterans (mean age: 73.7; SD: 11.6) who died on an acute or intensive care unit across 121 VAMCs between October 2010 and September 2015. Mediation analyses were used to assess whether five care processes (potentially burdensome transitions, high-intensity EOL treatment, and the BFS factors of Care and Communication, Emotional and Spiritual Support, and Death Benefits) significantly affected the association between Veteran race/ethnicity and a poor/fair BFS overall rating.
Potentially burdensome transitions, high-intensity EOL treatment, and the three BFS factors of Care and Communication, Emotional and Spiritual Support, and Death Benefits did not substantially mediate the relationship between Veteran race/ethnicity and poor/fair overall ratings of quality of EOL care by bereaved family members.
The reasons underlying poorer ratings of quality of EOL care among bereaved family members of racial/ethnic minority Veterans remain largely unexplained. More research on identifying potential mechanisms, including experiences of racism, and the unique EOL care needs of racial and ethnic minority Veterans and their families is warranted.
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Details
- Title
- Care processes and racial/ethnic differences in family reports of end-of-life care among Veterans: A mediation analysis
- Creators
- Ann Kutney-Lee - University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USAScarlett L Bellamy - Drexel UniversityMary Ersek - Center for Health Equity Research and Promotion Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia Pennsylvania USAElina L Medvedeva - Center for Health Equity Research and Promotion Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia Pennsylvania USADawn Smith - Veterans Health AdministrationJoshua M Thorpe - VA Pittsburgh Healthcare SystemJ Margo Brooks Carthon - University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Publication Details
- Journal of the American Geriatrics Society (JAGS), v 70(4), pp 1095-1105
- Publisher
- Wiley
- Grant note
- I01HX002190 / U.S. Department of Veterans Affairs Health Services Research and Development Service I01 HX002190 / HSRD VA
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Epidemiology and Biostatistics
- Web of Science ID
- WOS:000738805500001
- Scopus ID
- 2-s2.0-85122306444
- Other Identifier
- 991019167985604721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Geriatrics & Gerontology
- Gerontology