Advance directives among people living with HIV: room for improvement

Abstract

While HIV has become a largely chronic disease, age-associated comorbidities are prevalent in people living with HIV (PLWH). Therefore, PLWH are appropriate for advance care planning (ACP) and advance directives (ADs) completion. We sought to characterize AD completion among outpatient PLWH. We conducted a retrospective chart review of PLWH who receive their routine care at the University of Wisconsin HIV clinic. Data were extracted from the electronic health record. Variables were entered into a stepwise multivariate logistic regression model to assess which factors were independently associated with AD completion. Five hundred and eighty eight charts were reviewed. Eighty-one percent of subjects were male and 72% were white; mean age was 46.8 years. ADs were completed by 134 subjects and 6.7% of those were completed at the HIV clinic. In the final multivariate model, those who had completed an AD were more likely to be older than age 45; ever been diagnosed with AIDS; have cardiovascular disease, neurologic disorder, chronic kidney disease, or malignancy. In this study, a small percentage of patients had documented ADs, with only a small proportion completed in the HIV clinic. The HIV clinic is an underutilized resource to offer ACP. Interventions are needed to provide the necessary ACP resources for PLWH.

Have You Talked about It: Advance Care Planning among African Americans Living with HIV in Baltimore

“…It is possible that individuals who experienced more severe pain were more likely to discuss ACP with their care providers for several reasons. First, some of the individuals in this study were PLHIV with a history of opioids use, who would have needed to address their chronic pain and other comorbidities with healthcare providers [12][13][14][15][16]. Consequently, they may have been more likely to receive information on palliative care and/or other ACPrelated topics from their providers.…”

“…Due to the homogeneity of our sample across these characteristics, we did not adjust for several socio-demographic variables (e.g., income, insurance). Thus, while this population is often excluded in research [15,16], these population characteristics limit the generalizability of our findings.…”

“…Many of these individuals have co-morbid HIV, IDU, and chronic pain conditions such as hyperalgesia due to prolonged substance use [15]. While predictors of ACP remain understudied among all PLHIV [15,16], factors which encourage ACP are particularly important to identify among low-income African Americans, with comorbidities such as substance use and chronic pain [12][13][14][15][16].…”

Palliative Care, Hospice, and Advance Care Planning: Views of People Living with HIV and Other Chronic Conditions

“…Advance care planning for PLWH was encouraged when mortality was high, even though 50% or fewer PLWH were reported to have engaged in such planning with their health care providers (Haas et al, 1993; Wenger et al, 2001). In the current era of improved medical outcomes due to better antiretroviral therapy, the reported completion rate of advance care planning by PLWH continues in the range of 14-47% (Barocas, Erlandson, Belzer, Hess, & Sosman, 2015; de Caprariis, Carballo-Dieguez, Thompson, & Lyon, 2013; Erlandson et al, 2012). These results compare to advance directive completion rates of 26.3% in the general U.S. population (Rao, Anderson, Lin, & Laux, 2014) and 63% in a U.S. population of adults 65 years of age or older (Alano et al, 2010).…”

Correlates of Patterns of Health Values of African Americans Living With HIV/AIDS: Implications for Advance Care Planning and HIV Palliative Care

“…cancer, HIV) have slightly higher rates of advance directive completion (30%–47%), they are usually completed in hospital settings near end-of-life, providing little opportunity for discussion and clarification of patients’ health values. 5…”