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Correlates of patterns of health values of African Americans living with HIV/AIDS : implications for advance care planning and HIV palliative care
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CONTEXT & OBJECTIVE: Advance care planning (ACP) rates remain low, especially among people who are HIV positive, disadvantaged, and African American. While ACP can be a sensitive topic for clinicians and patients to discuss, health values clarification can be an important initial step.
METHODS: Data were from the first 325 participants in the AFFIRM Care study, which enrolled adults living with HIV/AIDS in Baltimore, MD, who had histories of illicit drug use. Respondents were asked whether (yes/no) they thought any of six health states would be worse than death: severe unremitting pain, total dependency on others, irreversible coma, being on mechanical ventilation, nursing home residence, and severe dementia. Latent class analysis (LCA) was used to group individuals by their pattern of responses, interpretable as preference for aggressive (life-sustaining) or non-aggressive (palliative) end-of-life care. Latent class regression (LCR) analysis was used to examine associations between class membership and background, health status, and social variables.
RESULTS: We found statistical support for a three-class LCA model: (1) the "Non-aggressive treatment" class, comprising 43% of cases, in which members perceived every state was worse than death; (2) the "Aggressive treatment" class, comprising 33% of cases, in which members perceived none of the states was worse than death; and (3) the "Mixed" class (24% of cases), in which members perceived only four of the six states were worse than death.
CONCLUSIONS: Three-quarters of participant response patterns had clear preferences for treatment decisions. Further research is needed to ensure inclusion of end-of-life scenarios relevant to this population.
http://dx.doi.org/10.1016/j.jpainsymman.2018.02.020
Voir la revue «JOURNAL OF PAIN AND SYMPTOM MANAGEMENT»
Autres numéros de la revue «JOURNAL OF PAIN AND SYMPTOM MANAGEMENT»
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