Advance Care Planning among Midlife and Older Adult Sexual Minority Men

项目摘要。 在严重疾病或生命结束时，许多美国人接受不必要的护理，包括生命- 长期和痛苦的干预，并在机构环境中死亡。预先护理计划（ACP）许可证 个人沟通他们的喜好，如果他们成为无法作出决定， 由于身体、认知和/或沟通障碍而需要自己的医疗护理。ACP改善了 人的愿望和他们所接受的护理之间的一致性，以及增加ACP的使用， 为病人、亲属和家庭以及卫生保健系统带来好处。对ACP了解甚少 中年和老年男同性恋、双性恋和其他男男性行为者之间的差异和预测因素 （GBMSM）。现有的ACP研究有许多空白，GBMSM有独特的生活经历，限制了 从现有的数据中概括出一般人群中的ACP行为。目前还不知道是否 ACP在不同的社会人口群体中存在差异，如种族、民族和社会经济 GBMSM的状态。还需要确定可能影响ACP行为的心理社会因素 在GBMSM中。本研究将探讨两种ACP行为（医疗保健）的正式和非正式维度 代理人，预先指示）使用多中心艾滋病队列研究的二级数据分析， GBMSM的纵向研究，包括社会人口统计学、健康和医疗保健方面的广泛数据，以及 心理社会因素具体目标是：1）描述预先护理计划的类型和程度 (ACP)在中年和老年GBMSM中，并评估社会人口统计学中的潜在差异 2）评估ACP患病率在纵向健康指标中的差异， 卫生保健的获得和利用;和3）测试心理社会因素和ACP之间的关联， 这些关联是否在HIV血清状态组之间存在差异。这项研究对了解ACP至关重要 在年龄较大的GBMSM中，开发适合文化的ACP模型，并解决组内 差距。GBMSM中ACP发生率的提高支持了与患者需求一致的高质量护理 在重病期间或生命结束时的愿望。这些发现也将推动更广泛的领域的非加太 通过检查在ACP研究中更普遍地未充分研究的因素（例如， 社会心理因素）。

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).