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Differences in veterans' and nonveterans' end-of-life preferences: a pilot study.

Duffy SA, Ronis D, Fowler K, Schim SM, Jackson FC. Differences in veterans' and nonveterans' end-of-life preferences: a pilot study. Journal of palliative medicine. 2006 Oct 1; 9(5):1099-105.

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BACKGROUND: Investigators conducting focus groups on end-of-life preferences noted that veterans voiced opinions that strongly differed from those of nonveterans. OBJECTIVE: The objective of this study was to further explore differences between veterans' and nonveterans' end-of-life preferences. METHODS: Ten focus groups and a pilot survey were conducted. SETTING AND SAMPLE: The focus groups consisted of Arab Muslims, Arab Christians, Hispanics, blacks, and whites stratified by gender (n = 73). Fifteen male veterans were included across all five racial groups. MEASURES: A moderator discussion guide was used to lead the focus groups and a pilot survey asked about demographic information and end-of-life preferences. RESULTS: Veterans were more likely to be married (p < 0.05) and less connected to their cultural group (p < 0.05) than nonveterans. The focus group results indicated that veterans in this study were more likely to oppose the use of heroic measures compared to nonveterans. More so than nonveterans, veterans felt that their doctors should be frank and open (p < 0.05) were strongly in favor of do-not-resuscitate (DNR) orders (p < 0.10), yet were less likely to have a proxy (p < 0.10) or durable power of attorney p < 0.01). Comparing end-of-life preferences, veterans felt less strongly than nonveterans about remembering personal accomplishments (p < 0.05), being listened to (p < 0.05), being with friends (p < 0.01), or being comfortable with their nurse (p < 0.05), but did want to be around their pets at the end of life p < 0.10). IMPLICATIONS: The Department of Veterans Affairs is in a unique position to improve endof- life care for veterans. Providing end-of-life care that is congruent with the veteran's wishes can improve satisfaction and increase cost effectiveness by eliminating unacceptable services.

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