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

Mary M. Mitchell, Eric D. Hansen, Tuo Yen Tseng, Meng Shen, Cynthia H Rushton, Thomas J Smith, Nancy Hutton, Jennifer Wolfe, Lee R Bone, Jeanne C Keruly, Lawrence S Wissow, Zachary Catanzarite, Amy Ruth Knowlton

Research output: Contribution to journalArticle


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.

Original languageEnglish (US)
Pages (from-to)53-62
Number of pages10
JournalJournal of Pain and Symptom Management
Issue number1
StatePublished - Jul 1 2018



  • advance care planning
  • African American
  • end-of-life scenarios
  • health values clarification
  • life-sustaining or palliative care preferences

ASJC Scopus subject areas

  • Nursing(all)
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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