Many dying vets unaware of end-of-life benefits

A member of the U.S. Armed forces stands as U.S. Army paratroopers parachute in the sky during a Veterans Day ceremony and rededication of the Intrepid Sea, Air, & Space Museum in New York November 11, 2008. (

NEW YORK (Reuters Health) - U.S. military veterans' benefits include palliative care and hospice care, but a small study of terminally ill vets suggests many don't understand these benefits -- or the nature of their own illness.

The findings show that health care providers need to do a better job of getting the word out about these services so dying patients can take advantage of them before it is too late, Dr. Alice Running of the University of Nevada in Reno and her colleagues say.

Palliative care is aimed at easing a person's symptoms, for example pain or difficulty breathing, but is not intended to cure an illness or halt its progress. The VA pays for "full-scale" hospice and palliative care, Running and her team note in their report in the International Journal of Older People Nursing, and all VA hospitals have palliative care consultation teams on staff.

Patients who receive care from these teams, which include doctors, nurses, social workers and counselors, are less likely to wind up in intensive care, the researchers point out, and more likely to work with health care providers to make sure their end-of-life preferences are realized.

Running and her team interviewed 17 veterans receiving palliative care as inpatients at a VA hospital to assess how knowledgeable they were about the services available to them, their own health, and their own goals for end of life care. Most had cancer, lung disease, or liver disease, all were men, and they ranged in age from 50 to 99.

Five of the men didn't know or understand their diagnosis, while 10 didn't understand that they were terminally ill, the researchers found. "These numbers reflect the gap in information that the veterans were receiving not only about their condition, but also about the services they could be receiving," the researchers write.

Eleven of the men understood what a "do not resuscitate" order was, but just four knew what an advanced directive was and reported having one on record. Advanced directives are statements about a person's preferences for end-of-life care, including identification of another individual who will make decision for that person if he or she is no longer able to.

Fourteen of the patients said they had made funeral arrangements, while 15 could name what was most important to them at this stage of their lives.

"It is necessary that this very important aspect of care, education about palliative care, hospice, comfort care and advanced directives begin in primary care clinics, before individuals find themselves in acute care with so many unknowns," Running and her colleagues say. "Providers need to educate patients and their families in these terms well before families will need to use them."

SOURCE: International Journal of Older People Nursing, March 2009.