The Living Well Project: Early Palliative Care and MI for persons with AIDS

描述（由申请人提供）：现在建议在诊断出危及生命的疾病时进行早期姑息治疗。我们计划测试一种增强的早期姑息治疗（EPC）服务模式对新诊断为艾滋病并在乔治亚州亚特兰大格雷迪卫生系统（GHS）住院或门诊传染病项目（IDP）住院的人的疗效。我们的艾滋病EPC包包括3次姑息治疗访问和4次每周一次的动机性访谈（MI）会议，以提供支持性护理、症状管理、促进对诊断的调整和提前护理计划决策。该项目有三个具体目标：1。进行一项随机对照试验，检查艾滋病EPC一揽子干预与标准艾滋病护理（SOC）的疗效，并比较基线后12个月的结果。我们的假设是，艾滋病EPC组的患者将具有：i)更好的临床结果：较低的一年死亡率，较高的开始抗逆转录病毒治疗（ART）的比例，较高的病毒学抑制比例，较高的CD4增加，较少的机会性感染（OI），较少的住院治疗，较低的抑郁评分，以及更好的症状管理（包括认知功能障碍）。ii)更好的社会心理结果：更好的应对技能，更高的感知社会支持，更高的灵性，更高水平的自我倡导，更低

DESCRIPTION (provided by applicant): Early palliative care is now recommended for persons at the time of diagnosis of a life threatening illness. We plan to test the efficacy of an enhanced model of early palliative care (EPC) services for persons newly diagnosed with AIDS and admitted to either the inpatient service or outpatient infectious disease program (IDP) at the Grady Health System in Atlanta, GA (GHS). Our AIDS EPC Package includes 3 palliative care visits and four weekly motivational interviewing (MI) sessions to provide supportive care, symptom management, and facilitate adjustment to diagnosis and advance care planning decision making. The project has three specific aims: 1. Conduct a RCT to examine the efficacy of the AIDS EPC Package intervention vs. standard HIV care (SOC) and compare outcomes at 12 months post baseline. Our hypothesis is that those in the AIDS EPC group will have: i) Better clinical outcomes: a lower one year mortality, higher proportion who initiate antiretroviral therap (ART), higher proportion with virologic suppression, higher CD4 gain, fewer opportunistic infections (OI), fewer hospitalizations, lower depression scores, and better symptom management (including cognitive dysfunction). ii) Better psychosocial outcomes: Better coping skills, higher perceived social support, higher spirituality, higher levels of self-advocacy, lower proportion who report substance use. iii) Better Quality of Life (QOL) and a higher proportion who report advance care planning activities: named a surrogate; set personal goals regarding life saving measures; and discussed these goals with a surrogate. 2. Evaluate the cost effectiveness and cost utility of the AIDS EPC Package compared to SOC where the outcomes are valued as survival and quality-adjusted life years (QALYs) respectively. 3. Promote engagement and retention in HIV care as evidenced by keeping a higher proportion of appointments and reporting higher satisfaction with care compared to SOC. We believe palliative care (PC) - with a focus on supportive, symptom-oriented care - is an ideal method to optimize the treatment of newly diagnosed persons with AIDS and promote engagement and retention in care. The comprehensive and multidisciplinary administered AIDS EPC Package includes spiritual, social, psychological, cognitive, and symptom management, with the addition of four weekly one-on-one motivational interviewing sessions conducted by nurses to facilitate disease adjustment and decision making about advance care planning. We posit that integrating EPC in the care of newly diagnosed AIDS patients will greatly improve QOL, clinical and psychosocial outcomes, and advance care planning at a lower cost than standard care. This caring approach will enhance engagement and retention in care and promote movement toward personal self-advocacy and quality of life.