Cause of death information is a vital resource for family and public health, yet significant issues persist regarding its determination, documentation and communication. In this study, we aim to characterize cause of death attribution process from the perspective of next-of-kin of Veterans who died in Veterans Affairs (VA) Medical Centers. Using a semi-structured guide, we explored next-of-kin's experiences of the Veteran's terminal hospitalization and conducted a content analysis of interview texts. In over two-third of cases next-of-kin's understanding was not consistent with their recollection of physicians' determination of cause of death. Discrepancies between official cause of death and lay understanding engendered confusion and distress. Findings have relevance for shaping the context of post-death patient/family-centered clinical practice and serve as a means for improving efficacy of cause of death communication and reducing potential for misunderstandings.
Department of Health Centers for Disease Control and Prevention. National Center for Human Services Health Statistics. Physicians’ Handbook on Medical Certification of Death. Hyattsville, MD: DHHS Publication No. (PHS) 2004-1108CDEC, 2003. https://www.cdc.gov/nchs/data/misc/hb_cod.pdf. Accessed December 28, 2017.
2.
LuTHShihTPLeeMCChouMCLinCK. Diversity in death certification: a case vignette approach. J Clin Epidemiol. 2001;54(11):1086–1093.
3.
ChengTJLinCYLuTHKawachiI. Reporting of incorrect cause-of-death causal sequence on death certificates in the USA: using hypertension and diabetes as an educational illustration. Postgrad Med J. 2012;88(1046):690–693.
4.
RampatigeRMikkelsenLHernandezBRileyILopezAD. Systematic review of statistics on causes of death in hospitals: strengthening the evidence for policy-makers. Bull World Health Organ. 2014;92(11):807–816.
5.
KlijsBNusselderWJMackenbachJP. Nationwide individual record linkage study showed poor agreement of causes of death and hospital diagnoses at individual level but reasonable agreement at population level. J Clin Epidemiol. 2014;67(2):160–168.
6.
DashSKBeheraBKPatroS. Accuracy in certification of cause of death in a tertiary care hospital—a retrospective analysis. J Forensic Leg Med. 2014;24:33–36.
7.
GovindanSShapiroLLangaKMIwashynaTJ. Death certificates underestimate infections as proximal causes of death in the U.S. PLoS One. 2014;9(5):e97714.
8.
HallenbeckJ.Palliative care in the final days of life; “they were expecting it at any time”. JAMA. 2005;293(18):2265–2271.
9.
HalanychJHShuaibFParmarG. Agreement on cause of death between proxies, death certificates, and clinician adjudicators in Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Am J Epidemiol. 2011;173(11):1319–1326.
10.
WilliamsBRWoodbyLLBaileyFABurgioKL. Identifying and responding to ethical and methodological issues in after-death interviews with next-of-kin. Death Stud. 2008;32(3):197–236.
11.
WoodbyLLWilliamsBRWittichARBurgioKL. Expanding the notion of researcher distress: the cumulative effects of coding. Qual Health Res. 2011;21(6):830–838.
WendlerDRidA. Systematic review the effect on surrogates of making treatment decisions for others. Ann Intern Med. 2011;154(5):336–346.
14.
RandallS. Death certification: a primer. Part I—an introduction to the death certificate. S D Med. 2014;67(5):196–197, 199.
15.
BussmannSMudersPZahrt-OmarCA. Improving end-of-life care in hospitals: a qualitative analysis of bereaved families’ experiences and suggestions. Am J Hosp Palliat Care. 2015;32(1):44–51.
16.
SchonfeldTLStevensEALampmanMALyonsWL. Assessing challenges in end-of-life conversations with elderly patients with multiple morbidities. Am J Hosp Palliat Care. 2012;29(4):260–267.
17.
AgarwalSSKumarAGVKumarLChavaliK. A study on appraisal of effectiveness of the MCCD scheme. J Indian Acad Forensic Med. 2010;32(4):318–320.
18.
OngPGambateseMBegierEZimmermanRSotoAMadsenA. Effect of cause-of-death training on agreement between hospital discharge diagnoses and cause of death reported, inpatient hospital death, New York City, 2008-2010. Prev Chronic Dis. 2015;12:EO4.
19.
AzimASinghPBhatiaP. Impact of an educational intervention on errors in death certification: an observational study from the intensive care unit of a tertiary care teaching hospital. J Anaesthesiol Clin Pharmacol. 2014;30(1):78–81.
20.
KamauC. Effects of experimental inductions for newly qualified doctors on competence at clinical procedures. Clin Med (Lond). 2014;14(4):380–385.
21.
Hemans-HenryCGreeneCMKoppakaR. Integrating public health-oriented e-learning into graduate medical education. Am J Prev Med. 2012;42(6 Suppl 2):S103–S106.
22.
MadsenAThihalolipavanSMaduroG. An intervention to improve cause-of-death reporting in New York City hospitals, 2009-2010. Prev Chronic Dis. 2012;9:E157.
23.
WalkerSRampatigeRWainiqoloIAumuaA. An accessible method for teaching doctors about death certification. HIM J. 2012;41(1):4–10.
24.
BaileyFAWilliamsBR. Preparation of residents for death pronouncement: a sensitive and supportive method. Palliat Support Care. 2005;3(2):107–114.
25.
KauferMMurphyPBarkerKMosenthalA. Family satisfaction following the death of a loved one in an inner city MICU. Am J Hosp Palliat Care. 2008;25(4):318–325.
26.
KitesJAKalishmanSKingsleyDDMinesJLawrenceE. Palliative medicine death rounds: small group learning on a vital subject. Am J Hosp Palliat Care. 2009;25(6):483–491.
