Care processes and racial/ethnic differences in family reports of end-of-life care among Veterans: A mediation analysis.
Care processes and racial/ethnic differences in family reports of end-of-life care among Veterans: A mediation analysis.
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DOI：
10.1111/jgs.17632
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发表时间：
2022-04
影响因子：
6.3
通讯作者：
Brooks Carthon JM
中科院分区：
文献类型：
--
作者：
Kutney-Lee A;Bellamy SL;Ersek M;Medvedeva EL;Smith D;Thorpe JM;Brooks Carthon JM
与白色退伍军人的家庭相比，少数种族/族裔退伍军人的失去亲人的家庭成员不太可能对临终（EOL）护理质量提供良好的总体评级;然而，这些差异的潜在机制尚未被探索。本研究的目的是检查是否一组EOL护理过程中的措施介导退伍军人种族/民族和丧亲家庭的整体评级的质量在退伍军人医疗中心（VAMCs）的EOL护理之间的关联。一个回顾性的，横断面分析的相关丧亲家庭调查（BFS），行政和临床数据进行。该样本包括17，911名退伍军人（平均年龄：73.7; SD：11.6），他们在2010年10月至2015年9月期间在121个VAMC的急性或重症监护室死亡。中介分析被用来评估是否五个护理过程（潜在的负担过渡，高强度的EOL治疗，以及护理和沟通，情感和精神支持，死亡福利的BFS因素）显着影响退伍军人种族/民族和一个穷人/公平的BFS整体评级之间的关联。潜在的负担过渡，高强度的EOL治疗，以及护理和沟通，情感和精神支持，死亡福利的三个BFS因素并没有实质性的调解退伍军人种族/民族和穷人/公平的整体评级之间的关系，由丧亲家庭成员的EOL护理质量。种族/少数民族退伍军人的丧亲家庭成员中EOL护理质量较差的原因在很大程度上仍然无法解释。更多的研究确定潜在的机制，包括种族主义的经验，以及种族和少数民族退伍军人及其家庭独特的EOL护理需求是必要的。
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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DOI：
10.1177/1049909119827933
发表时间：
2019-06-01
影响因子：
1.9
作者：
McCleskey, Sara G.;Cain, Cindy L.
通讯作者：
Cain, Cindy L.
影响因子：
3
作者：
Elixhauser, A;Steiner, C;Coffey, RN
通讯作者：
Coffey, RN
影响因子：
2.8
作者：
Lu, Hien;Trancik, Emily;Casarett, David
通讯作者：
Casarett, David
影响因子：
7.1
作者：
Fairchild, Amanda J.;McDaniel, Heather L.
通讯作者：
McDaniel, Heather L.
影响因子：
6.2
作者：
Ersek, Mary;Miller, Susan C.;Mor, Vincent
通讯作者：
Mor, Vincent