• David Casarett, Amy Pickard, F Amos Bailey, Christine Seel Ritchie, Christian Davis Furman, Ken Rosenfeld, Scott Shreve, and Judy Shea.
• Center for Health Equity Research and Promotion, Philadelphia VAMC, Philadelphia, Pennsylvania, USA. Casarett@mail.upenn.edu
• J Palliat Med. 2008 Jan 1; 11 (1): 68-75.

ObjectivesTo 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.DesignNationwide telephone survey.SettingFive VA medical centers.ParticipantsEligible patients received inpatient or outpatient care from a participating VA facility in the last month of life. One respondent/patient was selected using predefined eligibility criteria and invited to participate.MeasurementsThe FATE survey consists of 32 items in 9 domains: Well-being and dignity (4 items), Information and communication (5 items), Respect for treatment preferences (2 items), Emotional and spiritual support (3 items), Management of symptoms (4 items), Choice of inpatient facility (1 item), Care around the time of death (6 items), Access to VA services (4 items), and Access to VA benefits after the patient's death (3 items).ResultsInterviews were completed with 309 respondents. The FATE showed excellent psychometric characteristics, with good homogeneity (e.g., Cronbach (alpha = 0.91) and no evidence of significant ceiling effects. The FATE also demonstrated good discriminant validity. For instance, FATE scores varied across facilities (range 44-72; Kruskal Wallis test p < 0.001). Patients who were seen by a palliative care service had better scores (mean 66 versus 52; rank sum test p < 0.001), as did patients who were referred to hospice (67 versus 49; rank sum test p < 0.001).ConclusionsThe FATE survey offers an important source of quality data that can be used to improve the end-of-life care of all veterans, regardless of the type of care they receive or their site of death.

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