"That is care that you just can't fake!": Identifying Best Practices for the Care of Vietnam Veterans at End of Life.

Abstract Context We reviewed the Veterans Health Administration (VHA) Bereaved Family Survey's (BFS) open-ended responses to understand end of life care (EOL) best practices for Vietnam and pre-Vietnam Veterans. Objectives To identify: 1) recommendations for improved EOL care enhancements for older Veterans 2) a model of best practices in EOL care for Veterans, and 3) any relevant differences in best practices between Vietnam and prior war eras. Methods We examined five years of BFS data (n=2,784), collected between 2013 and 2017, from bereaved family members of Veterans focusing on 2 open-ended questions: 1) Is there anything else you would like to share about the Veteran's care during his last month of life? 2) Is there anything else you would like to share about how the care could have been improved for the Veteran? Applied thematic analysis identified successes and challenges in the experience of the bereaved of Vietnam and pre-Vietnam era Veterans. Results Regardless of war era and death venue, a patient-centered approach to EOL care with readily available staff who: 1) provide ongoing support, comfort, honor, and validation; 2) routinely adjust to the patient's changing needs; 3) and provide clear, honest, timely, compassionate communication, was important to the bereaved. Consideration of the uniqueness of Vietnam Veterans is beneficial. Conclusions Patient-centered EOL care should include assigning a point of contact that follows the patient, educates the family on expectations, ensures the patient's changing needs are met, ensures the family has appropriate support, and communicates updates to family throughout the patient's care continuum.