title: A nationwide study comparing end-of-life care for men and women veterans.
abstract: BACKGROUND
  The quality of end-of-life (EOL) care at Veterans Affairs Medical Centers (VAMC) has improved. To date, however, the quality and outcomes of end-of-life care delivered to women veterans have not been examined.
  
  
  OBJECTIVE
  The goal of this study was to evaluate gender differences in the quality of EOL care received by patients in VAMCs nationwide.
  
  
  METHODS
  The study was conducted via retrospective medical chart review and telephone survey with next of kin of recently deceased inpatients.
  
  
  METHODS
  The chart review included records for all patients who died in acute and long-term care units in 145 VAMCs nationwide (n=36,618). For the survey, the documented next of kin were invited to respond on behalf of the deceased veteran; a total of 25,638 next of kin completed the survey.
  
  
  METHODS
  Chart review measures included five indicators of optimal end-of-life care. Bereaved family survey items included one global and nine specific items (e.g., bereavement care, pain management) describing care in the last month of life.
  
  
  RESULTS
  Receipt of optimal end-of-life care did not differ significantly between women and men with respect to frequency of discussion of treatment goals with a family member, receipt of palliative consult, bereavement contact, and chaplain contact with a family member. Family members of women were more likely than those of men to report that the overall care provided to the veteran had been "excellent" (adjusted proportions: 63% versus 56%; odds ratio (OR)=1.33; 95% confidence interval (CI) 1.10-1.61; p=0.003).
  
  
  CONCLUSIONS
  In this nationwide study of all inpatient deaths in VAMCs, women received comparable and on some metrics better quality EOL care than that received by male patients.
authors.affiliation: PROMISE Center, Center for Health Equity Research and Promotion, Department of Veterans Affairs Medical Center, Philadelphia, Pennsylvania 19104, USA. ersekm@nursing.upenn.edu
authors.forename: Mary
authors.initials: M
authors.lastname: Ersek
authors.forename: Dawn
authors.initials: D
authors.lastname: Smith
authors.forename: Carolyn
authors.initials: C
authors.lastname: Cannuscio
authors.forename: Diane M
authors.initials: DM
authors.lastname: Richardson
authors.forename: Denise
authors.initials: D
authors.lastname: Moore
mesh_terms: D001601:Bereavement; D005260:Female; D054625:Healthcare Disparities / Q000592:standards*; D006787:Hospitals, Veterans / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008499:Medical Records; D054526:Men's Health; D015999:Multivariate Analysis; D011368:Professional-Family Relations; D011787:Quality of Health Care / Q000592:standards*; D012189:Retrospective Studies; D017678:Sex Distribution; D013727:Terminal Care / Q000379:methods / Q000458:organization & administration / Q000592:standards*; D014481:United States; D016387:Women's Health