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

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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.