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OBJECTIVE To examine the severity of impairments in the decision-making abilities (understanding, appreciation, reasoning, and choice) and competency to make a decision to use an Alzheimer disease (AD)-slowing medication in patients with AD and the relationships between these impairments, insight, and overall cognition. METHODS Semistructured in-home(More)
Quality improvement initiatives have become a major force in shaping health care. These initiatives are diverse but share a common goal of generating knowledge that will guide improvements in health care. Although quality improvement occupies an uncertain territory between clinical care and research, this difference is extremely important. If a quality(More)
CONTEXT Hospice care may improve the quality of end-of-life care for nursing home residents, but hospice is underutilized by this population, at least in part because physicians are not aware of their patients' preferences. OBJECTIVE To determine whether it is possible to increase hospice utilization and improve the quality of end-of-life care by(More)
OBJECTIVES To determine whether inpatient palliative consultation services improve outcomes of care. DESIGN Retrospective telephone surveys conducted with family members of veterans who received inpatient or outpatient care from a Department of Veterans Affairs (VA) medical facility in the last month of life. SETTING Five VA Medical Centers or their(More)
OBJECTIVES To evaluate the FATE (Family Assessment of Treatment at End of Life) Survey for use as a nationwide quality measure in the VA health care system. DESIGN Nationwide telephone survey. SETTING Five VA medical centers. PARTICIPANTS Eligible patients received inpatient or outpatient care from a participating VA facility in the last month of(More)
Patients with advanced cancer face difficult decisions regarding their treatment, and many will need to make difficult choices about end-of-life care because although cancer-directed therapies are increasingly available, few provide a cure. High-quality cancer care includes access to palliative care throughout the cancer care continuum, and increasing(More)
BACKGROUND Paying patients to participate in clinical trials is ethically controversial. However, there has been no empirical documentation regarding whether payment represents an undue or unjust inducement. METHODS To evaluate these questions, we described hypothetical placebo-controlled trials of a new antihypertensive drug to 126 patients with(More)
CONTEXT HIV infection has become a manageable chronic disease. There are few studies of pain and symptoms in the current treatment era. OBJECTIVES Our primary objective was to determine the prevalence of and risk factors for pain and physical and psychological symptoms in a population of ambulatory HIV patients. METHODS We performed a cross-sectional(More)
OBJECTIVES To examine the capacity, competency, and reasons for enrolling of patients with Alzheimer's disease (AD) and of their caregivers in an early phase AD clinical trial. DESIGN Interviews were conducted with patients with AD, nondemented older persons, and caregivers. SETTING Participants' homes. PARTICIPANTS Fifteen patients with mild to(More)
BACKGROUND The Veterans Affairs (VA) has made significant investments in care for veterans. However, it is not known whether these investments have produced improvements in end-of-life care in the VA compared to other settings. Therefore, the goal of this study was to compare families' perceptions of end-of-life care among patients who died in VA and non-VA(More)