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Nationwide Veterans Affairs Quality Measure for Cancer: The Family Assessment of Treatment at End of Life

Esme Finlay, Scott Shreve, David Casarett

From the Division of Hematology/Oncology, University of Pennsylvania; VA Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs (VA) Medical Center, Philadelphia; Lebanon VA Medical Center, Lebanon, PA; and Office of Geriatrics and Extended Care, Washington, DC

Corresponding author: David Casarett, MD, Ralston-Penn Center, 3615 Chestnut St, Rm 304, University of Pennsylvania, Philadelphia, PA 19104; e-mail: casarett{at}mail.med.upenn.edu

The Veterans Affairs (VA) health care system has created a national initiative to measure quality of care at the end of life. This article describes the first phase of this national initiative, the Family Assessment of Treatment at End of Life (FATE), in evaluating the quality of end-of-life care for veterans dying with cancer. In the initial phase, next of kin of patients from five VA Medical Centers were contacted 6 weeks after patients' deaths and invited to participate in a telephone interview, and surrogates for 262 cancer patients completed FATE interviews. Decedents were 98% male with an average age of 72 years. There was substantial variation among sites. Higher FATE scores, consistent with family reports of higher satisfaction with care, were associated with palliative care consultation and hospice referral and having a Do Not Resuscitate order at the time of death, whereas an intensive care unit death was associated with lower scores. Early experience with FATE suggests that it will be a helpful tool to characterize end-of-life cancer care and to identify targets for quality improvement.

The views expressed here are those of the authors and do not represent the official position of the Department of Veterans Affairs.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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