Late Transitions and Bereaved Family Member Perceptions of Quality of End-of-Life Care

Lena K. Makaroun, Joan Teno, Vicki A. Freedman, Judith D. Kasper, Pedro Gozalo, Vincent Mor

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objectives: To examine associations between healthcare transitions at the end of life (EOL; late transitions) and bereaved family members' and friends' assessment of EOL quality of care (QOC). Design: National Health and Aging Trends Study (NHATS), a prospective cohort of Medicare enrollees aged 65 and older. Setting: United States, all sites of death. Participants: Family members and close friends of decedents from NHATS Rounds 2 through 6 (N=1,653; weighted 6.0 million Medicare deaths). Measurements: Multivariable logistic regression with survey weights was used to examine the association between having a late transition and reports of perceived unmet needs for symptom management, spiritual support, concerns with communication, and overall QOC. Results: Seventeen percent of decedents had a late transition. Bereaved respondents for decedents experiencing late transitions were more likely to report that the decedent was treated without respect (21.3% vs 15.6%; adjusted odds ratio (AOR)=1.59, 95% confidence interval (CI)=1.09–2.33), had more unmet needs for spiritual support (67.4% v 55.2%; AOR=1.48, 95% CI=1.03–2.13), and were more likely to report they were not kept informed about the person's condition (31.0% vs 20.9%; AOR=1.54, 95% CI=1.07–2.23). Bereaved respondents were less likely to rate QOC as excellent when there was a late transition (43.6% vs 48.2%; AOR=0.79, 95% CI=0.58–1.06). Subgroup analyses of those experiencing a transition between a nursing home and hospital (13% of all late transitions) revealed such transitions to be associated with even worse QOC. Conclusion: Transitions in the last 3 days of life are associated with more unmet needs, higher rate of concerns, and lower rating of QOC than when such late transitions are absent, especially when that transition is between a nursing home and hospital.

Original languageEnglish (US)
Pages (from-to)1730-1736
Number of pages7
JournalJournal of the American Geriatrics Society
Volume66
Issue number9
DOIs
StatePublished - Sep 1 2018

Fingerprint

Terminal Care
Quality of Health Care
Quality of Life
Odds Ratio
Confidence Intervals
Medicare
Nursing Homes
Health
Logistic Models
Communication
Prospective Studies
Delivery of Health Care
Weights and Measures
Surveys and Questionnaires

Keywords

  • end-of-life care
  • healthcare transitions
  • quality of care

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Late Transitions and Bereaved Family Member Perceptions of Quality of End-of-Life Care. / Makaroun, Lena K.; Teno, Joan; Freedman, Vicki A.; Kasper, Judith D.; Gozalo, Pedro; Mor, Vincent.

In: Journal of the American Geriatrics Society, Vol. 66, No. 9, 01.09.2018, p. 1730-1736.

Research output: Contribution to journalArticle

Makaroun, Lena K. ; Teno, Joan ; Freedman, Vicki A. ; Kasper, Judith D. ; Gozalo, Pedro ; Mor, Vincent. / Late Transitions and Bereaved Family Member Perceptions of Quality of End-of-Life Care. In: Journal of the American Geriatrics Society. 2018 ; Vol. 66, No. 9. pp. 1730-1736.
@article{194f24c87c3a480b9b4a566df8b4ee79,
title = "Late Transitions and Bereaved Family Member Perceptions of Quality of End-of-Life Care",
abstract = "Objectives: To examine associations between healthcare transitions at the end of life (EOL; late transitions) and bereaved family members' and friends' assessment of EOL quality of care (QOC). Design: National Health and Aging Trends Study (NHATS), a prospective cohort of Medicare enrollees aged 65 and older. Setting: United States, all sites of death. Participants: Family members and close friends of decedents from NHATS Rounds 2 through 6 (N=1,653; weighted 6.0 million Medicare deaths). Measurements: Multivariable logistic regression with survey weights was used to examine the association between having a late transition and reports of perceived unmet needs for symptom management, spiritual support, concerns with communication, and overall QOC. Results: Seventeen percent of decedents had a late transition. Bereaved respondents for decedents experiencing late transitions were more likely to report that the decedent was treated without respect (21.3{\%} vs 15.6{\%}; adjusted odds ratio (AOR)=1.59, 95{\%} confidence interval (CI)=1.09–2.33), had more unmet needs for spiritual support (67.4{\%} v 55.2{\%}; AOR=1.48, 95{\%} CI=1.03–2.13), and were more likely to report they were not kept informed about the person's condition (31.0{\%} vs 20.9{\%}; AOR=1.54, 95{\%} CI=1.07–2.23). Bereaved respondents were less likely to rate QOC as excellent when there was a late transition (43.6{\%} vs 48.2{\%}; AOR=0.79, 95{\%} CI=0.58–1.06). Subgroup analyses of those experiencing a transition between a nursing home and hospital (13{\%} of all late transitions) revealed such transitions to be associated with even worse QOC. Conclusion: Transitions in the last 3 days of life are associated with more unmet needs, higher rate of concerns, and lower rating of QOC than when such late transitions are absent, especially when that transition is between a nursing home and hospital.",
keywords = "end-of-life care, healthcare transitions, quality of care",
author = "Makaroun, {Lena K.} and Joan Teno and Freedman, {Vicki A.} and Kasper, {Judith D.} and Pedro Gozalo and Vincent Mor",
year = "2018",
month = "9",
day = "1",
doi = "10.1111/jgs.15455",
language = "English (US)",
volume = "66",
pages = "1730--1736",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",
number = "9",

}

TY - JOUR

T1 - Late Transitions and Bereaved Family Member Perceptions of Quality of End-of-Life Care

AU - Makaroun, Lena K.

AU - Teno, Joan

AU - Freedman, Vicki A.

AU - Kasper, Judith D.

AU - Gozalo, Pedro

AU - Mor, Vincent

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Objectives: To examine associations between healthcare transitions at the end of life (EOL; late transitions) and bereaved family members' and friends' assessment of EOL quality of care (QOC). Design: National Health and Aging Trends Study (NHATS), a prospective cohort of Medicare enrollees aged 65 and older. Setting: United States, all sites of death. Participants: Family members and close friends of decedents from NHATS Rounds 2 through 6 (N=1,653; weighted 6.0 million Medicare deaths). Measurements: Multivariable logistic regression with survey weights was used to examine the association between having a late transition and reports of perceived unmet needs for symptom management, spiritual support, concerns with communication, and overall QOC. Results: Seventeen percent of decedents had a late transition. Bereaved respondents for decedents experiencing late transitions were more likely to report that the decedent was treated without respect (21.3% vs 15.6%; adjusted odds ratio (AOR)=1.59, 95% confidence interval (CI)=1.09–2.33), had more unmet needs for spiritual support (67.4% v 55.2%; AOR=1.48, 95% CI=1.03–2.13), and were more likely to report they were not kept informed about the person's condition (31.0% vs 20.9%; AOR=1.54, 95% CI=1.07–2.23). Bereaved respondents were less likely to rate QOC as excellent when there was a late transition (43.6% vs 48.2%; AOR=0.79, 95% CI=0.58–1.06). Subgroup analyses of those experiencing a transition between a nursing home and hospital (13% of all late transitions) revealed such transitions to be associated with even worse QOC. Conclusion: Transitions in the last 3 days of life are associated with more unmet needs, higher rate of concerns, and lower rating of QOC than when such late transitions are absent, especially when that transition is between a nursing home and hospital.

AB - Objectives: To examine associations between healthcare transitions at the end of life (EOL; late transitions) and bereaved family members' and friends' assessment of EOL quality of care (QOC). Design: National Health and Aging Trends Study (NHATS), a prospective cohort of Medicare enrollees aged 65 and older. Setting: United States, all sites of death. Participants: Family members and close friends of decedents from NHATS Rounds 2 through 6 (N=1,653; weighted 6.0 million Medicare deaths). Measurements: Multivariable logistic regression with survey weights was used to examine the association between having a late transition and reports of perceived unmet needs for symptom management, spiritual support, concerns with communication, and overall QOC. Results: Seventeen percent of decedents had a late transition. Bereaved respondents for decedents experiencing late transitions were more likely to report that the decedent was treated without respect (21.3% vs 15.6%; adjusted odds ratio (AOR)=1.59, 95% confidence interval (CI)=1.09–2.33), had more unmet needs for spiritual support (67.4% v 55.2%; AOR=1.48, 95% CI=1.03–2.13), and were more likely to report they were not kept informed about the person's condition (31.0% vs 20.9%; AOR=1.54, 95% CI=1.07–2.23). Bereaved respondents were less likely to rate QOC as excellent when there was a late transition (43.6% vs 48.2%; AOR=0.79, 95% CI=0.58–1.06). Subgroup analyses of those experiencing a transition between a nursing home and hospital (13% of all late transitions) revealed such transitions to be associated with even worse QOC. Conclusion: Transitions in the last 3 days of life are associated with more unmet needs, higher rate of concerns, and lower rating of QOC than when such late transitions are absent, especially when that transition is between a nursing home and hospital.

KW - end-of-life care

KW - healthcare transitions

KW - quality of care

UR - http://www.scopus.com/inward/record.url?scp=85050397353&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85050397353&partnerID=8YFLogxK

U2 - 10.1111/jgs.15455

DO - 10.1111/jgs.15455

M3 - Article

VL - 66

SP - 1730

EP - 1736

JO - Journal of the American Geriatrics Society

JF - Journal of the American Geriatrics Society

SN - 0002-8614

IS - 9

ER -