End-of-life discussions and preferences among persons with HIV
End-of-life discussions and preferences among persons with HIV
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DOI：
10.1001/jama.285.22.2880
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发表时间：
2001-06-13
影响因子：
120.7
通讯作者：
Shapiro, MF
中科院分区：
文献类型：
--
作者：
Wenger, NS;Kanouse, DE;Shapiro, MF
预先护理计划的缺陷使许多患者和他们的医生对临终关怀的决定毫无准备。尽管他的预后是；事实证明，对于许多人体免疫缺陷病毒（艾滋病毒）感染者来说，仍然需要进行规划。目的评估艾滋病毒感染者中临终讨论的流行程度、预先指示的使用和临终关怀的偏好，以及它们与患者人口统计学、临床状况、社会心理变量和从业者特征的关系。从1996年1月至1997年4月，对2864名美国概率样本进行了横断面调查，其中代表了23400名接受艾滋病毒治疗的成年人。与医生就临终问题进行沟通，完成预先指示，对积极治疗的偏好，并愿意容忍未来永久的不良健康状态。结果1432名患者（50%）与医生讨论了临终关怀的某些方面，1088名患者（38%）完成了临终关怀预嘱。在与医生讨论后，患者更有可能完成预先指示（优势比[OR]， 5.82； 95%可信区间[CI]， 4.50-7.52）。从业者与黑人（OR, 0.57; 95% CI, 0.39-0.83）和拉丁裔（OR, 0.74; 95% CI, 0.55-0.98）讨论临终关怀的时间少于与白人。女性（OR, 1.39; 95% CI, 1.05-1.84）和家中有孩子的患者（OR, 1.53; 95% CI, 1.12-2.10）与医生就临终问题沟通最多。通过注射吸毒感染艾滋病毒的患者（OR, 0.64; 95% CI, 0.45-0.89）和受教育程度较低的患者与医生就临终问题沟通最少。更少的否认，对医生更大的信任，更长的医患关系与更多的提前护理计划有关。结论：一半的艾滋病毒感染者在没有事先与他们的保健医生讨论的情况下，有做出生命终结决定的风险。黑人、拉丁美洲人、静脉注射吸毒者和受教育程度较低的个人需要在临床艾滋病毒项目中进行预先护理计划干预。
Context Deficits in advance care planning leave many patients and their physicians unprepared for decisions about end-of-life care. Even though the prognosis has im; proved for many persons with human immunodeficiency virus (HIV) infection, a need for planning remains.Objective To evaluate prevalence of end-of-life discussions, use of advance directives, and preferences concerning end-of-life care and their relationship with patient demographics, clinical status, psychosocial variables, and practitioner characteristics among HIV-infected persons.Design, Setting, and Patients Cross-sectional survey of a US probability sample of 2864, which represents 231 400 adults receiving care for HIV, conducted from January 1996 to April 1997.Main Outcome Measures Communication with physician regarding end-of-life issues, completion of an advance directive, preference for aggressiveness of care,and willingness to tolerate future permanent adverse health states.Results A total of 1432 patients (50%) discussed some aspect of end-of-life care with their practitioner and 1088 (38%) completed an advance directive. Patients were more likely to complete an advance directive after a physician discussion (odds ratio [OR], 5.82; 95% confidence interval [CI], 4.50-7.52). Practitioners discussed end-of-life care less with blacks (OR, 0.57; 95% CI, 0.39-0.83) and Latinos (OR, 0.74; 95% CI, 0.55-0.98) than with whites. Women (OR, 1.39; 95% CI, 1.05-1.84) and patients with children in the household (OR, 1.53; 95% CI, 1.12-2.10) communicated the most with practitioners about end-of-life issues. Patients infected with HIV via injection drug use (OR, 0.64; 95% CI, 0.45-0.89) and those with less education communicated the least with physicians about end-of-life issues. Less denial, greater trust in one's practitioner, and longer patient-practitioner relationship were associated with more advance care planning.Conclusions: Half of all persons infected with HIV are at risk of making end-of-life decisions without prior discussions with their health care practitioners. Blacks, Latinos, intravenous drug users, and less educated individuals need advance care planning interventions in clinical HIV programs.