Association Between Mental Health Diagnoses and Process of Care at the End Of Life: Findings from the BEACON Trial

•Gain knowledge on mental health disparities in end of life care.•Identify at least three quality indicators of end-of-life care processes that are associated with mental health diagnoses. Mental health disparities have garnered increasing interest in the last two decades. Patients diagnosed with mental disorders are less likely to receive optimal care in various health care settings; however, little is known about the relationship between mental health diagnoses and processes of care at the end of life. Our study aimed to determine whether the presence of mental health diagnoses was correlated with specific processes of care in the last 7 days of life. Data were drawn from the Best Practices for End-of-Life Care for Our Nation’s Veterans (BEACON) trial conducted between 2005 and 2011. Five processes of care were identified as primary end points as indicators of quality end-of-life (EOL) care, including opioid order, do not resuscitate order (DNR), intravenous line infusing at time of death, nasogastric tube, and physical restraints. Generalized estimating equation (GEE) modeling was conducted to examine the association between mental health diagnoses and each process of care. Among the 5476 inpatient decedents (mean [SD] age, 70.1 [22.5]), 98.2% were male, 65.2 were white, and 34.4% were black. Over a half had a terminal diagnosis of cancer (30.1%) or heart disease (20.1%). After controlling for covariates, patients with any mental health diagnosis were less likely to have IV infusion at time of death (OR=0.80, p=.001) but more likely to have DNR (OR=1.23, P=.002) and physical restraints (OR=1.23, P=.004) compared to those without. No differences were observed in other processes. Significant differences were observed for several EOL processes of care between veterans with mental disorders and those without. Patients with comorbid mental conditions were more likely to receive care that was directed at controlling symptoms or supporting DNR.