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Psychometric Evaluation of the Veterans Affairs Bereaved Family Survey in Community Nursing Homes

  • Daniel Kinder
    Correspondence
    Address correspondence to: Daniel Kinder, MPH, Corporal Michael J. Crescenz VAMC, 3900 Woodland Avenue, Building 4100, Philadelphia, PA 19104, USA.
    Affiliations
    Veteran Experience Center (D.K.,D.S.,A.K-L.), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
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  • Joshua Thorpe
    Affiliations
    Center for Health Equity Research and Promotion (J.T,), Pittsburgh VA Medical Center, Pittsburgh, Pennsylyania, USA

    UNC Eshelman School of Pharmacy (J.T.), Chapel Hill, North Carolina, USA
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  • Dawn Smith
    Affiliations
    Veteran Experience Center (D.K.,D.S.,A.K-L.), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
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  • Melissa Wachterman
    Affiliations
    Veterans Affairs Boston Healthcare System (M.W.), Boston, Massachusetts, USA

    Division of General Internal Medicine and Primary Care, Department of Medicine (M.W.), Brigham and Women's Hospital, Boston, Massachusetts, USA

    Department of Psychosocial Oncology and Palliative Care (M.W.), Dana Farber Cancer Institute, Boston, Massachusetts, USA
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  • Ann Kutney-Lee
    Affiliations
    Veteran Experience Center (D.K.,D.S.,A.K-L.), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA

    University of Pennsylvania School of Nursing (A.K-L.), Philadelphia, Pennsylyania, USA
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      Abstract

      Context

      For over a decade, the Department of Veterans Affairs (VA) has used the Bereaved Family Survey (BFS) to measure the quality of end-of-life (EOL) care in VA inpatient settings. In 2019, VA developed a revised version of the BFS to evaluate the quality of EOL care for Veterans who received hospice services in VA-contracted community nursing homes (CNHs).

      Objectives

      The purpose of this analysis was to evaluate the psychometric properties and factor structure of the BFS-CNH.

      Methods

      The BFS-CNH was administered to the next-of-kin of Veterans who died in a VA-contracted CNH with hospice care between October 2019 and April 2020. Exploratory factor analysis (EFA) was used with the 10 core items of the BFS-CNH that were derived from the inpatient BFS to evaluate whether the BFS-CNH exhibited a similar factor structure to the inpatient version. Cronbach's alpha was used to assess internal consistency/reliability of the identified factors and linear regression models were used to evaluate construct validity of the identified BFS-CNH factor scores and individual items.

      Results

      The EFA revealed a three-dimension solution that corresponded to factors on the inpatient BFS, including Care and Communication, Emotional and Spiritual Support and Death Benefits. Cronbach's alpha coefficients for all three factors indicated acceptable internal consistency.

      Conclusion

      Our findings provide support for use of the BFS-CNH to evaluate the quality of EOL care provided to Veterans in CNHs and lay the foundation for future comparisons of BFS ratings between VA inpatient and CNH settings.

      Key Words

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