Study identifies factors for disparities in preoperative goals-of-care documentation rates

For a cohort of veterans, disparities in preoperative life-sustaining treatment (LST) documentation rates persist based on race and ethnicity, rurality of residence, and history of mental health disability, according to a study published online Dec. 19 in JAMA Network Open.

Adela Wu, M.D., from the U.S. Department of Veterans Affairs in Palo Alto, California, and colleagues conducted a retrospective cross-sectional study using data from the Veterans Healthcare Administration involving 229,737 veterans who underwent surgical procedures to examine the association of patient- and system-level factors with preoperative LST note documentation or no LST note documentation within 30 days prior to or on the day of surgery.

The researchers found that 5.8% of patients who received surgery completed preoperative LST. Patients who were female, those who were Black or Hispanic, or those from rural areas; those with a history of mental disability; and those who were seen at lowest-complexity facilities tended to complete preoperative documentation less often. Despite the COVID-19 pandemic, patients undergoing surgical procedures completed preoperative LST increasingly more often over time.

Patients of racial or ethnic-minority background and patients from rural regions had lower likelihoods of completing LST compared with white or non-Hispanic patients and those from urban areas in covariate-adjusted analyses. The likelihood of completing preoperative LST was also lower for patients with any history of mental health disability.

"Our study reinforces the persistence of racial and ethnic disparities and highlights other patient-level gaps in goals of care documentation for the surgical patient population," the authors write.

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