Support Network Factors Associated With Naming a Health Care Decision-Maker and Talking About Advance Care Planning Among People Living With HIV
Support Network Factors Associated With Naming a Health Care Decision-Maker and Talking About Advance Care Planning Among People Living With HIV
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DOI：
10.1016/j.jpainsymman.2019.08.019
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发表时间：
2019-12-01
影响因子：
4.7
通讯作者：
Knowlton，Amy R.
中科院分区：
文献类型：
--
作者：
Cruz-Oliver，Dulce M.;Tseng，Tuo-Yen;Knowlton，Amy R.
非洲裔美国人或晚期艾滋病毒感染者（PLHIV）中与预先护理计划（ACP）相关的社会环境因素很少受到关注。目的本研究旨在确定支持网络因素，这些因素会影响易感PLHIV患者选择决策者、与家人/朋友和医生谈论ACP的可能性。方法从大型城市HIV门诊招募HIV感染者。使用社会支持网络量表来计算可获得各种类型支持的人数。还收集了网络成员的特征。多变量逻辑回归模型适合检验社会网络因素与ACP讨论之间的关系，调整了年龄、性别、教育程度和网络成员总数。结果样本（N= 370）主要是非裔美国人（95%），男性（56%），48%的人高中以下教育程度。近一半的样本（48%）曾与家人/朋友或医生谈论过ACP， 34%的人曾提到过医疗决策者。调整后的分析显示，与家人/朋友谈论ACP与女性和提供健康信息和身体援助的更大更亲密的支持网络有关。与医生谈论ACP与更大的支持网络有关，这些支持网络提供物理帮助，但从他们那里获得情感支持的人数较少。指定一个决策者与更多提供情感支持、健康信息和药物依从提醒的网络成员有关。结论研究结果揭示了家庭/支持网络结构和护理功能与ACP相关的各个方面，这些网络通常是重要但脆弱的。
ContextLittle attention has been given to social environmental factors associated with advance care planning (ACP) among African Americans or people living with advanced HIV (PLHIV).ObjectivesThe present study aimed to identify support network factors that affect the likelihood of naming a decision-maker and of talking to family/friends and doctors about ACP among vulnerable PLHIV.MethodsPLHIV were recruited from a large urban HIV clinic. A social support network inventory was used to calculate number of persons available for various types of support. Characteristics of network members were also collected. Multivariable logistic regression models were fit to examine associations between social network factors and ACP discussion, adjusting for age, sex, education, and total number of network members.ResultsThe sample (N= 370) was mostly African American (95%), male (56%), and 48% had less than a high school education. Almost half the sample (48%) had talked to their family/friends or doctor about ACP, and 34% had named a medical decision-maker. Adjusted analysis revealed that talking about ACP with family/friends was associated with female sex and a larger closer support network who provided health information and physical assistance. Talking to doctors about ACP was associated with larger support networks who provided physical assistance but lower numbers from whom emotional support was received. Naming a decision-maker was associated with greater numbers of network members who provided emotional support, health information, and medication adherence reminders.ConclusionThe findings revealed aspects of family/support network structures and caregiving function associated with ACP in a population with often vital yet vulnerable networks.