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Publication Briefs

Veterans with a Racial/Ethnic Minority Background, Rural Residence, or Mental Health Disability History Were Less Likely to Complete Preoperative Goals of Care Documentation

Preoperative life-sustaining treatment (LST) documentation is important for Veterans who will undergo surgery, a major healthcare stressor that incurs risk. This cross-sectional study assessed factors – including race, ethnicity, rurality, history of mental health disability, and VA facility type – that are known or hypothesized to be linked with disparities in LST documentation. The study also described the COVID-19 pandemic’s effect on completion of preoperative LST. Researchers reviewed the VA data of 229,737 Veterans (91% male, mean age 66), who underwent surgeries at VA facilities between January 1, 2017, and October 18, 2022, and who had used VHA services for at least one year prior to their surgery. The primary outcome was preoperative LST documentation within 30 days prior to or on the day of surgery.


  • Veterans with a racial or ethnic minority background, rural residence, mental health disability history, or who were seen at low-complexity, low-volume facilities were significantly less likely to complete preoperative LST compared to Veterans who were white or non-Hispanic, urban residents, without a mental health disability history, or who had access to a high-complexity, high-volume facility.
  • Of the 229,737 Veterans in the cohort, 13,408 (6%) completed preoperative LST documentation within 30 days prior to surgery.
  • With each passing year, Veterans undergoing surgical procedures had greater likelihoods of completing LST before surgery, including during the COVID-19 pandemic.


  • There is continued need for interventions that target Veteran groups at risk of not engaging in serious illness communication.


  • It is possible that LST discussions occurred but with poor documentation.
  • The study model did not account for all possible factors, including the diagnostic vs. therapeutic nature of procedures.

Drs. Wu, Giannitrapani, Garcia, Bozkurt, Boothroyd, Kim, and Lorenz and Messrs. Zhang and McCaa are part of HSR&D’s Center for Innovation to Implementation (Ci2i) in Palo Alto, CA. Dr. Giannitrapani was funded by an HSR&D Career Development Award.

Wu A, Giannitrapani KF, Garcia A, Bozkurt S, Boothroyd D, Adams A, Kim KM, Zhang S, McCaa MD, Morris AM, Shreve S, Lorenz KA. Disparities in Preoperative Goals of Care Documentation in Veterans. JAMA Network Open. December 19, 2023; 6(12):e2348235.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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