TY - JOUR
T1 - Correlates of Patterns of Health Values of African Americans Living With HIV/AIDS
T2 - Implications for Advance Care Planning and HIV Palliative Care
AU - Mitchell, Mary M.
AU - Hansen, Eric D.
AU - Tseng, Tuo Yen
AU - Shen, Meng
AU - Rushton, Cynda
AU - Smith, Tom
AU - Hutton, Nancy
AU - Wolfe, Jennifer
AU - Bone, Lee
AU - Keruly, Jeanne
AU - Wissow, Lawrence
AU - Catanzarite, Zachary
AU - Knowlton, Amy R.
N1 - Funding Information:
This study was supported by grants R01 DA019413 and R01 NR14050-01 and the Center for AIDS Research grant 1P30 AI094189 from the National Institutes of Health.
Publisher Copyright:
© 2018 American Academy of Hospice and Palliative Medicine
PY - 2018/7
Y1 - 2018/7
N2 - Context: Advance care planning rates remain low, especially among people who are HIV positive, disadvantaged, and African American. Although advance care planning can be a sensitive topic for clinicians and patients to discuss, health values clarification can be an important initial step. Objectives: The purpose of the study was to explore health values of African Americans living with HIV/AIDS and to examine correlates of these values. Methods: Data were from the first 325 participants in the AFFIRM Care study, which enrolled adults living with HIV/AIDS in Baltimore, Maryland, 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 was used to group individuals by their pattern of responses, interpretable as preference for aggressive (life-sustaining) or nonaggressive (palliative) end-of-life care. Latent class regression 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 latent class analysis model: 1) the nonaggressive treatment class, comprising 43% of cases, in which members perceived that every state was worse than death; 2) the aggressive treatment class, comprising 33% of cases, in which members perceived that none of the states was worse than death; and 3) the mixed class (24% of cases), in which members perceived that only four of the six states were worse than death. Conclusion: 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.
AB - Context: Advance care planning rates remain low, especially among people who are HIV positive, disadvantaged, and African American. Although advance care planning can be a sensitive topic for clinicians and patients to discuss, health values clarification can be an important initial step. Objectives: The purpose of the study was to explore health values of African Americans living with HIV/AIDS and to examine correlates of these values. Methods: Data were from the first 325 participants in the AFFIRM Care study, which enrolled adults living with HIV/AIDS in Baltimore, Maryland, 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 was used to group individuals by their pattern of responses, interpretable as preference for aggressive (life-sustaining) or nonaggressive (palliative) end-of-life care. Latent class regression 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 latent class analysis model: 1) the nonaggressive treatment class, comprising 43% of cases, in which members perceived that every state was worse than death; 2) the aggressive treatment class, comprising 33% of cases, in which members perceived that none of the states was worse than death; and 3) the mixed class (24% of cases), in which members perceived that only four of the six states were worse than death. Conclusion: 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.
KW - African American
KW - HIV/AIDS
KW - advance care planning
KW - end-of-life scenarios
KW - health values clarification
KW - life-sustaining or palliative care preferences
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U2 - 10.1016/j.jpainsymman.2018.02.020
DO - 10.1016/j.jpainsymman.2018.02.020
M3 - Article
C2 - 29526613
AN - SCOPUS:85048830567
SN - 0885-3924
VL - 56
SP - 53
EP - 62
JO - Journal of Pain and Symptom Management
JF - Journal of Pain and Symptom Management
IS - 1
ER -