title: Physicians "missing in action": family perspectives on physician and staffing problems in end-of-life care in the nursing home.
abstract: OBJECTIVE
  To understand the roles of physicians and staff in nursing homes in relation to end-of-life care through narrative interviews with family members close to a decedent.
  
  
  METHODS
  Qualitative follow-up interviews with 54 respondents who had participated in an earlier national survey of 1,578 informants.
  
  
  METHODS
  Brown University interviewers conducted telephone interviews with participants throughout the United States.
  
  
  METHODS
  The 54 participants agreed to a follow-up qualitative interview and were family members or close to the decedent.
  
  
  METHODS
  A five-member, multidisciplinary team to identify overarching themes taped, transcribed, and then coded interviews.
  
  
  RESULTS
  Respondents report that healthcare professionals often insufficiently address the needs of dying patients in nursing homes and that "missing in action" physicians and insufficient staffing create extra burdens on dying nursing home residents and their families.
  
  
  CONCLUSIONS
  Sustained efforts to increase the presence of physicians and improve staffing in nursing homes are suggested to improve end-of-life care for dying residents in nursing homes.
authors.affiliation: Center for Gerontology and Health Care Research, Brown University, Providence, Rhode Island 02912, USA. Renee_Shield@brown.edu
authors.forename: Renée R
authors.initials: RR
authors.lastname: Shield
authors.forename: Terrie
authors.initials: T
authors.lastname: Wetle
authors.forename: Joan
authors.initials: J
authors.lastname: Teno
authors.forename: Susan C
authors.initials: SC
authors.lastname: Miller
authors.forename: Lisa
authors.initials: L
authors.lastname: Welch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003258:Consumer Behavior / Q000706:statistics & numerical data*; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006707:Homes for the Aged; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009732:Nursing Care; D009735:Nursing Homes; D009740:Nursing Staff / Q000600:supply & distribution; D010820:Physicians / Q000600:supply & distribution*; D011368:Professional-Family Relations; D011785:Quality Assurance, Health Care; D013727:Terminal Care; D014481:United States; D000078329:Workforce