Female Veteran Use of Palliative and Hospice Care: A Scoping Review

Abstract

Introduction The number of female veterans in the USA in the age range of 55-64 years increased 7-fold from 2000 to 2015. Female veterans are more likely to suffer from certain mental health disorders, respiratory diseases, neurologic diseases, and some forms of cancer when compared to their male counterparts. Veterans Affairs (VA) healthcare providers need to be prepared to care for this growth of female veterans with serious illness. These serious illnesses require appropriate medical management, which often includes palliative care. It is imperative to determine how VA healthcare providers integrate palliative and hospice care for this population. The purpose of our scoping review was to explore the palliative and hospice care literature specific to female veterans to learn: (1) what evidence is available regarding female veterans’ use of palliative and hospice care? (2) To meet the needs of this growing population, what gaps exist specific to female veterans’ use of palliative and hospice care? Methods A scoping review methodology was employed following the nine-step process described by the Joanna Briggs Institute for conducting scoping reviews. Results Nineteen articles met the inclusion criteria. Fourteen quantitative articles were included which comprised 10 retrospective chart reviews, one randomized controlled trial, one correlation, one quality improvement, and one cross-sectional. The remaining five were qualitative studies. The sample populations within the articles were overwhelmingly male and white. Content analysis of the articles revealed three themes: quality of end of life care, distress, and palliative care consult. Conclusions The female veteran population is increasing and becoming more ethnically diverse. Female veterans are not well represented in the literature. Our review also uncovered a significant gap in the study methodologies. We found that retrospective chart reviews dominated the palliative and hospice care literature specific to veterans. More prospective study designs are needed that explore the veteran and family experience while receiving end of life care. With the rising number of older female veterans and their risk for serious illness, it is imperative that research studies purposefully recruit, retain, analyze, and report female veteran statistics along with their male counterparts. We can no longer afford to disregard the value of the female veterans’ perspective.

Military Veterans' End of Life

“…Numerous studies have documented a higher quality of life, complemented by a greater longevity when Veterans receive EOL care (Haverhals et al, 2019; Institute of Medicine, 2015). According to Varilek and Isaacson (2021), the greatest satisfaction with EOL care occurs when admission to hospice is started 1 to 3 months before projected death. Relevant information about EOL can affect the planning of appropriate care, anticipating and documenting the individual's wishes, improving communication between patients and health providers, and promoting shared decision-making.…”

“…Varilek and Isaacson (2021) reported a lack of research exploring women Veterans and EOL experiences. Women Veterans of color cited increased stress from their documented difficulty receiving treatment, disability ratings, and benefits for their behavioral health issues (Redd et al, 2020).…”

“…Although anger helped them cope with military stress and defend themselves in the masculine warrior culture, anger could produce barriers to a peaceful EOL (Burkhart & Hogan, 2015). Varilek and Isaacson (2021) reported a lack of research exploring women Veterans and EOL experiences. Women Veterans of color cited increased stress from their documented difficulty receiving treatment, disability ratings, and benefits for their behavioral health issues (Redd et al, 2020).…”

“…There is limited information about end-of-life (EOL) care for Veterans in civilian healthcare systems (Chargualaf et al, 2021). With growing access by Veterans to community-based healthcare afforded by the 2018 Veteran's Administration MISSION Act legislation, civilian clinicians will be increasingly called upon to address and manage Veteran care at EOL (Chargualaf et al, 2021; Varilek & Isaacson, 2021). The purpose of this article is to provide bio-psycho-social information to civilian clinicians so they can assist Veterans in non-VHA settings find solace, respect, and serenity at EOL.…”

“…Military Veterans' End of Life: Supporting Them in Their Last Deployment civilian clinicians will be increasingly called upon to address and manage Veteran care at EOL (Chargualaf et al, 2021;Varilek & Isaacson, 2021). The purpose of this article is to provide bio-psycho-social information to civilian clinicians so they can assist Veterans in non-VHA settings find solace, respect, and serenity at EOL.…”