Advance Care Planning among Midlife and Older Adult Sexual Minority Men

项目摘要。 在严重疾病或生命垂危的时候，许多美国人会得到不必要的护理，包括生命- 长期和痛苦的干预，并在机构环境中消亡。提前护理计划(ACP)许可证 个人交流他们的偏好，如果他们变得无法就他们的 由于身体、认知和/或沟通障碍而受到的医疗护理。机场核心计划改善 人们的愿望和他们所得到的照顾之间的一致性，增加机场核心计划的利用率可以 使患者、亲属和家人以及医疗保健系统受益。人们对机场核心工程知之甚少 中老年同性恋者、双性恋者和其他与男性发生性行为的男性之间的差异和预测因素 (GBMSM)。现有的ACP研究存在许多空白，而GBMSM具有独特的生活经验，限制了 从现有的关于普通人群中ACP行为的数据中得出结论。目前还不清楚是否 ACP在种族、民族和社会经济等社会人口统计群体中存在差异 GBMSM中的地位。还需要确定可能影响ACP行为的心理社会因素 在GBMSM中。本研究将考察两种ACP行为(医疗保健)的正式和非正式维度 代理，高级指令)使用来自多中心艾滋病队列研究的辅助数据分析， 对GBMSM的纵向研究，包括社会人口学、卫生保健和医疗保健等方面的大量数据 心理社会因素。具体目标是：1)描述预先护理计划的类型和范围 (ACP)中老年GBMSM，并评估社会人口之间的潜在差异 2)评估纵向健康指标和纵向健康指标之间ACP患病率的差异 卫生保健的获取和利用；以及3)心理社会因素与ACP之间的测试关联，以及 这些关联在HIV血清状态组中是否有所不同。这项研究对于理解ACP是至关重要的 在较老的GBMSM中，开发适合文化的ACP模型，并在集团内解决 差距。GBMSM中ACP发生率的提高支持与患者一致的高质量护理 在重病期间或生命末期的愿望。这些发现也将推动更广泛的机场核心工程领域 通过更一般地检查在ACP研究中未被充分研究的因素来推进研究(例如， 心理社会因素)。

Project Summary. In times of serious illness or at the end of life, many Americans receive unwanted care, including life- prolonging and painful interventions, and die in institutional settings. Advance care planning (ACP) permits individuals to communicate their preferences should they become unable to make decisions regarding their own medical care due to physical, cognitive, and/or communicative impairments. ACP improves the concordance between persons’ wishes and the care they receive, and increasing the utilization of ACP can yield benefits to patients, kin and families, and the health care system. Very little is known regarding ACP disparities and predictors among midlife and older adult gay, bisexual, and other men who have sex with men (GBMSM). Existing ACP research has numerous gaps, and GBMSM have distinct life experiences that limit generalizing from existing data regarding ACP behaviors in the general population. It is not known whether there are disparities in ACP across sociodemographic groups such as race, ethnicity, and socioeconomic status among GBMSM. There is also a need to identify psychosocial factors that may influence ACP behaviors among GBMSM. This research will examine formal and informal dimensions of two ACP behaviors (health care proxy, advance directives) using secondary data analyses from the Multicenter AIDS Cohort Study, a longitudinal study of GBMSM with extensive data on sociodemographics, health and health care, and psychosocial factors. The specific aims are to 1) Describe the types and extent of advance care planning (ACP) among midlife and older adult GBMSM, and assess potential disparities across sociodemographic groups; 2) Assess differences in the prevalence of ACP across longitudinal health indicators, and longitudinal health care access and utilization; and 3) Test associations between psychosocial factors and ACP, and whether these associations differ across HIV serostatus groups. This research is critical to understanding ACP among older GBMSM, developing culturally-appropriate models of ACP, and addressing within-group disparities. Improving rates of ACP among GBMSM supports high quality care that is concordant with patients’ wishes during severe illness or at the end of life. These findings will also move the broader field of ACP research forward by virtue of examining factors that are understudied in ACP research more generally (e.g., psychosocial factors).