Identifying Opportunities to Improve End-of-Life Care During the COVID-19 Pandemic Using Family Narrative Reports (FR214C)

OUTCOMES: 1. Apply bereaved family suggestions for improving end-of-life care quality in the context of COVID-19 2. Describe opportunities to improve end-of-life care quality using qualitative methods on family and caregiver narrative reports INTRODUCTION: The COVID-19 pandemic led to changes, such as visitation restrictions, that impacted the nature of care delivered to seriously ill patients, especially around including family and caregivers at the end of life. The VA Quality Improvement Resource Center (QuIRC) for palliative care aimed to identify actionable practices to improve end-of-life care quality during the global pandemic. METHODS: The VA's Bereaved Family Survey (BFS) is used nationally to gather routine feedback from families and caregivers of recent in-patient decedents. QuIRC leveraged the qualitative comments from the BFS. Between February 2020 and March 2021, there were 5,372 responses to two open-ended questions and one open share space in the VA's BFS, of which 1,000 (18.6%) responses were randomly selected. 445 (44.5%) of the responses were related to COVID-19. These were analyzed using standard qualitative content analysis with dual review. RESULTS: Four opportunities with a total of 32 actionable practices were suggested by bereaved family members. Opportunity 1: Facilitate the use of video communication (included four actionable practices). Opportunity 2: Provide timely and accurate responses to family concerns (included 17 actionable practices). Opportunity 3: Accommodate family/caregiver visitation at the end of life (included eight actionable practices). Supporting quote: “We were able to be with him as he took his last breath. We were so very thankful we were able to be with him.” Opportunity 4: Offer physical presence to the patient when family/caregivers are unable to visit (included three actionable practices). Supporting quote: “It was so comforting to know, sitting here in [remote location], that [patient name] was not dying all alone.” CONCLUSION: The findings from this quality improvement project are applicable during a global pandemic, but also translate to improving end-of-life care in all circumstances, such as when family members or caregivers are geographically distant.