Physicians "missing in action": family perspectives on physician and staffing problems in end-of-life care in the nursing home.

Objectives: To understand the roles of physicians and staff in nursing homes in relation to end-of-life care through narrative interviews with family members close to a decedent.

Design: Qualitative follow-up interviews with 54 respondents who had participated in an earlier national survey of 1,578 informants.

Setting: Brown University interviewers conducted telephone interviews with participants throughout the United States.

Participants: The 54 participants agreed to a follow-up qualitative interview and were family members or close to the decedent.

Measurements: A five-member, multidisciplinary team to identify overarching themes taped, transcribed, and then coded interviews.

Results: Respondents report that healthcare professionals often insufficiently address the needs of dying patients in nursing homes and that "missing in action" physicians and insufficient staffing create extra burdens on dying nursing home residents and their families.

Conclusion: Sustained efforts to increase the presence of physicians and improve staffing in nursing homes are suggested to improve end-of-life care for dying residents in nursing homes.