Confronting Mortality: Narratives of Military Veterans Enrolled in Home Hospice Care

Background: Nearly 85% of veterans who do enroll for Department of Veterans Affairs (VA) health services die outside VA facilities, yet little is known about the circumstances of their deaths. Although only 4% of veteran deaths actually occur within VA facilities, most of what we know about end-of-life needs and preferences of veterans has come from VA data and reflects only a small proportion of veterans' experiences at the end of life. Objective: The aim of this study was to advance the understanding and meaning of being a military veteran enrolled in home hospice care. Methods: A hermeneutic qualitative approach using thematic analysis was used to explore the meaning and significance of 15 narratives of military veterans between the ages of 56 and 95 years. In-depth, semistructured, face-to-face interviews were audio recorded and transcribed verbatim. A back-and-forth movement using inherent reading and rereading allowed the research team to be fully immersed in the data. After line-by-line coding, themes and subthemes were identified. Criteria for trustworthiness guided verification that the qualitative analysis represented the data. Results: Five themes emerged that described the meaning of being a military veteran at the end of life, including Limited Opportunities, Broken Relationships, Obligation, Military Service as a Life Influence Not Definition, and Lack of Fear/Acceptance of Death. Conclusions: Although narrowly focused on a particular population in home hospice care, these findings warrant distinction between dying while in service and dying through natural process. All participants spoke about how being a veteran did not serve as their core identity, rather they identified as individuals who have lived many colors. Implications: Although honoring and acknowledging veterans for their service to our country seem fundamental, clinicians should recognize that this gesture of respect can be viewed as disrespect. Individualized attention to veterans' meanings of life experiences may allow clinicians to more fully understand how to attend to veterans' needs at the end of life.