{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T11:05:50Z","timestamp":1776942350562,"version":"3.51.4"},"reference-count":30,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Preoperative goals of care discussion and documentation are important for patients undergoing surgery, a major health care stressor that incurs risk.<\/jats:p><\/jats:sec>Objective<\/jats:title>To assess the association of race, ethnicity, and other factors, including history of mental health disability, with disparities in preoperative goals of care documentation among veterans.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This retrospective cross-sectional study assessed data from the Veterans Healthcare Administration (VHA) of 229\u202f737 veterans who underwent surgical procedures between January 1, 2017, and October 18, 2022.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Patient-level (ie, race, ethnicity, medical comorbidities, history of mental health comorbidity) and system-level (ie, facility complexity level) factors.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Preoperative life-sustaining treatment (LST) note documentation or no LST note documentation within 30 days prior to or on day of surgery. The standardized mean differences were calculated to assess the magnitude of differences between groups. Odds ratios (ORs) and 95% CIs were estimated with logistic regression.<\/jats:p><\/jats:sec>Results<\/jats:title>In this study, 13\u202f408 patients (5.8%) completed preoperative LST from 229\u202f737 VHA patients (209\u202f123 [91.0%] male; 20\u202f614 [9.0%] female; mean [SD] age, 65.5 [11.9] years) who received surgery. Compared with patients who did complete preoperative LST, patients tended to complete preoperative documentation less often if they were female (19\u202f914 [9.2%] vs 700 [5.2%]), Black individuals (42\u202f571 [19.7%] vs 2416 [18.0%]), Hispanic individuals (11\u202f793 [5.5%] vs 631 [4.7%]), or from rural areas (75\u202f637 [35.0%] vs 4273 [31.9%]); had a history of mental health disability (65\u202f974 [30.5%] vs 4053 [30.2%]); or were seen at lowest-complexity (ie, level 3) facilities (7849 [3.6%] vs 78 [0.6%]). Over time, despite the COVID-19 pandemic, patients undergoing surgical procedures completed preoperative LST increasingly more often. Covariate-adjusted estimates of preoperative LST completion demonstrated that patients of racial or ethnic minority background (Black patients: OR, 0.79; 95% CI, 0.77-0.80; P<\/jats:italic>\u2009&amp;lt;.001; patients selecting other race: OR, 0.78; 95% CI, 0.74-0.81; P<\/jats:italic>\u2009&amp;lt;.001; Hispanic patients: OR, 0.78; 95% CI, 0.76-0.81; P<\/jats:italic>\u2009&amp;lt;.001) and patients from rural regions (OR, 0.91; 95% CI, 0.90-0.93; P<\/jats:italic>\u2009&amp;lt;.001) had lower likelihoods of completing LST compared with patients who were White or non-Hispanic and patients from urban areas. Patients with any mental health disability history also had lower likelihood of completing preoperative LST than those without a history (OR, 0.93; 95% CI, 0.92-0.94; P<\/jats:italic>\u2009=\u2009.001).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cross-sectional study, disparities in documentation rates within a VHA cohort persisted based on race, ethnicity, rurality of patient residence, history of mental health disability, and access to high-volume, high-complexity facilities.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.48235","type":"journal-article","created":{"date-parts":[[2023,12,19]],"date-time":"2023-12-19T16:00:37Z","timestamp":1703001637000},"page":"e2348235","source":"Crossref","is-referenced-by-count":2,"title":["Disparities in Preoperative Goals of Care Documentation in Veterans"],"prefix":"10.1001","volume":"6","author":[{"given":"Adela","family":"Wu","sequence":"first","affiliation":[{"name":"VA Health Services Research and 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California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alyce S.","family":"Adams","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Population Health, Stanford University, Stanford, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyung Mi","family":"Kim","sequence":"additional","affiliation":[{"name":"VA Health Services Research and Development Center for Innovation to Implementation, VA Palo Alto Health Care System, U.S. Department of Veterans Affairs, Palo Alto, California"},{"name":"Office of Research Patient Care Services, Stanford Health Care, Palo Alto, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shiqi","family":"Zhang","sequence":"additional","affiliation":[{"name":"VA Health Services Research and Development Center for Innovation to Implementation, VA Palo Alto Health Care System, U.S. Department of Veterans Affairs, Palo Alto, California"},{"name":"Quantitative 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