Measuring Families’ Perceptions of Care Across a Health Care System: Preliminary Experience with the Family Assessment of Treatment at End of Life Short Form (FATE-S)

Abstract 

Context

Because the Family Evaluation of Treatment at End of Life (FATE) survey was too long for routine use in the Veterans Administration (VA) health care system to measure quality of care, a shorter instrument was developed.

Objectives

To evaluate the short version of the FATE survey for use as a nationwide quality measure in the VA health care system.

Methods

Fifty-one VA medical centers, including acute and long-term care, participated in this nationwide telephone survey. Family members of the patients were eligible if the patients died in a participating facility. One family member per patient was selected from medical records using predefined eligibility criteria and invited to participate. The survey consists of 14 items describing key aspects of the patient’s care in his or her last month of life, one global rating, and two open-ended questions for additional comments.

Results

Interviews were completed with 2827 family members. Overall, the survey showed excellent psychometric characteristics, with good homogeneity (e.g., Cronbach’s α=0.84) and strong evidence of discriminant validity. Two survey items have been targeted for quality improvement efforts in multisite collaboratives.

Conclusion

Surveys of surrogates offer an important source of quality data that can be used to improve the quality of end-of-life care and promote accountability.

Key Words: End-of-life care, quality improvement, measurement, veterans