https://aub.ie/MilitaryREACH-Giannitrapani2022

Giannitrapani, K. F., Yefimova, M., McCaa, M. D., Goebel, J. R., Kutney-Lee, A., Gray, C., Shreve, S. T., & Lorenz, K. A. (2022). Using family narrative reports to identify practices for improving end-of-life care quality. Journal of Pain and Symptom Management, 64(4), 349-358. https://doi.org/10.1016/j.jpainsymman.2022.06.017

This study analyzed 1,800 narratives from family members of Veterans who received end-of-life care at a Veterans Health Administration (VHA) facility (e.g., hospice, nursing home). Researchers collected the narratives from open-ended responses on the Bereaved Family Survey (BFS), in which families offered suggestions for improving care. Qualitative narrative content analysis was used to identify actionable practices. The identified practices were then categorized into 5 domains related to the quality of palliative and end-of-life care.

https://doi.org/10.1016/j.jpainsymman.2022.06.017

Veterans
Physical health
Mental health

Multiple branches

Veteran

Spouse of service member or veteran
Child of a service member or veteran

Young adulthood (18 - 29 yrs)
Adulthood (18 yrs & older)
Thirties (30 - 39 yrs)
Middle age (40 - 64 yrs)

Qualitative Study

Giannitrapani, Karleen F., Yefimova, Maria, McCaa, Matthew D., Goebel, Joy R., Kutney-Lee, Ann, Gray, Caroline, Shreve, Scott T., Lorenz, Karl A.

Context Patient experiences should be considered by healthcare systems when implementing care practices to improve quality of end-of-life care. Families and caregivers of recent in-patient decedents may be best positioned to recommend practices for quality improvement. Objectives To identify actionable practices that bereaved families highlight as contributing to high quality end-of-life care. Methods We conducted qualitative content analysis of narrative responses to the Bereaved Family Surveys Veterans Health Administration inpatient decedents. Out of 5964 completed surveys in 2017, 4604 (77%) contained at least one word in response to the open-ended questions. For feasibility, 1500/4604 responses were randomly selected for analysis. An additional 300 randomly selected responses were analyzed to confirm saturation. Results Over 23% percent (355/1500) of the initially analyzed narrative responses contained actionable practices. By synthesizing narrative responses to the BFS in a national healthcare system, we identified 98 actionable practices reported by the bereaved families that have potential for implementation in QI efforts. Specifically, we identified 67 end-of-life practices and 31 practices in patient-centered care domains of physical environment, food, staffing, coordination, technology and transportation. The 67 cluster into domains including respectful care and communication, emotional and spiritual support, death benefits, symptom management. Sorting these practices by target levels for organizational change illuminated opportunities for implementation. Conclusion Narrative responses from bereaved family members can yield approaches for systematic quality improvement. These approaches can serve as a menu in diverse contexts looking for approaches to improve patient quality of death in in-patient settings.

Elsevier

Article
REACH Publication

Center for Innovation to Implementation (K.F.G., M.Y., M.D.M., J.R.G., C.G., K.A.L.), VA Palo Alto Health Care System, KFG
Center for Innovation to Implementation (K.F.G., M.Y., M.D.M., J.R.G., C.G., K.A.L.), VA Palo Alto Health Care System, MY
Center for Innovation to Implementation (K.F.G., M.Y., M.D.M., J.R.G., C.G., K.A.L.), VA Palo Alto Health Care System, MCM
Center for Innovation to Implementation (K.F.G., M.Y., M.D.M., J.R.G., C.G., K.A.L.), VA Palo Alto Health Care System, JRG
Center for Innovation to Implementation (K.F.G., M.Y., M.D.M., J.R.G., C.G., K.A.L.), VA Palo Alto Health Care System, CG
Center for Innovation to Implementation (K.F.G., M.Y., M.D.M., J.R.G., C.G., K.A.L.), VA Palo Alto Health Care System, KAL
Division of Primary Care and Population Health (K.F.G., K.A.L.), Stanford University School of Medicine, KFG
Division of Primary Care and Population Health (K.F.G., K.A.L.), Stanford University School of Medicine, KAL
Office of Research (M.Y.), Patient Care Services, Stanford Healthcare, MY
School of Nursing California State University Long Beach (J.R.G.), JRG
Veteran Experience Center (A.K.L.), Corporal Michael J. Crescenz VA Medical Center, AKL
University of Pennsylvania School of Nursing (A.K.L.), AKL
Hospice and Palliative Care Program (S.T.S.), US Department of Veteran Affairs, Hospice and Palliative Care Unit, Lebanon VA Medical Center, STS