LAUSR

CONTEXT Although bereaved family surveys are routinely used quantitatively for quality assessment, open-ended, narrative responses are rarely systematically analyzed. Analysis of narrative responses may identify opportunities for improving end-of-life (EOL) care delivery. OBJECTIVES To highlight the value of routine, systematic analysis of narrative responses, and to thematically summarize narrative responses to the VA's Bereaved Family Survey. METHODS We analyzed over 4600 open-ended responses to the Bereaved Family Survey for all 2017 inpatient decedents across VA facilities. We used a descriptive qualitative approach (9) to identify major themes. RESULTS Thematic findings clustered into three domains: patient needs, family needs, and facility and organizational characteristics. Patient needs include maintenance of Veteran's hygiene, appropriately prescribing medications, adhering to patient wishes, physical presence in patient's final hours, and spiritual and religious care at EOL. Family and caregiver needs included enhanced communication with the patient's care team, assistance with administrative and logistical challenges after death, emotional support, and displays of respect and gratitude for the patient's life. Facility and organizational characteristics included care team coordination, optimal staffing, the importance of non-clinical staff to care, and optimizing facilities to be welcoming, equipped for individuals with disabilities, and able to provide high quality food. CONCLUSION Systematic analysis of narrative survey data yields unique findings not routinely available through quantitative data collection and analysis. Organizations may benefit from the collection and regular analysis of narrative survey responses, which facilitates identification of needed improvements in palliative and EOL care that may improve the overall experiences for patients and families.