Abstract
Throughout the 1980’s, HIV antiretroviral therapy was non-existent or insufficient, and patients admitted to hospitals were frequently terminal. In 1988 we evaluated the HIV related hospitalizations at the Lutheran Medical Center in Brooklyn, New York, and found that only 1.3 % of the patients had an advanced directive/living will. Fifty percent of the patients expired during their hospitalization. To assist health care professionals during this serious illness, medical decisions were needed from the patients and, at other times, from family members and/or significant others. Subsequently, patients were approached to discuss advance directives (AD). With the introduction of the Highly Active Antiretroviral Therapy, medical management has decreased HIV mortality. Patients may have started having different perceptions on the need for an AD. The study design was submitted to the Institutional Review Board (IRB), and the IRB granted a HIPPA waiver because this was a retrospective study which delinked the study data from any identification of the patient. The chart reviews were conducted to ascertain the existence of an AD for all patients admitted at the Lutheran Medical Center, Brooklyn, NY from 2004 to 2011. One hundred eighty-two patients were identified from their discharge codes for HIV or AIDS. The median age was 47 years (range 22–85 years). Median time since HIV diagnosis was 9.5 years (range 0–28 years). Ninety-two percent lacked an AD on admission. From the thirty patients that were older than 54 years of age, only four of them had an AD prior to admission. During hospitalization only 11 patients out of 187 enacted a new AD, which decreased the overall percentage of patients lacking an AD to 86.3 % (pre and during admission). The majority of HIV infected patients hospitalized lacked an AD. Our data did not indicate a greater predominance of ADs from a private practice or clinic setting. ADs did not increase with increasing age. Moreover, with longer years with an HIV diagnosis, the number of ADs did not increase. Our results would indicate that a different approach is necessary to adequately address ADs with this specific population, especially as their longevity increases.
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References
Ramsaroop, D. S., Reid, M. C., & Alderman, R. D. (2007). Completing an advance directive in primary care setting: What do we need for success? The Journal of the American Geriatrics Society, 55, 277–283.
Schneiderman, L. J., & Arras, J. D. (1985). Counseling patients to counsel physicians on future care in the event of patient incompetence. Annals of Internal Medicine, 102, 693–698.
Towers, J. T. (1992). Advance care directives: Counseling the patient and family in the primary care setting. Nurse Practitioner Forum, 3(1), 25–27.
New York State Department of Health. (2012). The palliative health care act. http://www.health.ny.gov/professionals/patients/patient_rights/palliative_care/information_act.htm. Accessed 25 July 2012.
Madera, I., de Caprariis, P. J., Shidlo, A., & Visconti, E. (1993). AIDS, The nurse and the Do Not Resuscitate issue. Aids Patient Care, 7, 163–165.
Work Group for HIV and Aging Consensus Project. (2012). Summary report from the human immunodeficiency virus and aging consensus project: Treatment strategies for clinicians managing older individuals with Human Immunodeficiency virus. Journal of the American Geriatrics Society, 60, 974–979.
Madera, I., de Caprariis, P. J., Carballo-Dieguez, A., Rodriguez, G., Stehney, M., Dansky, D. F., et al. (1989). Approaching the “Do Not Resuscitate” issue with AIDS patients. Canadian Family Physician, 35, 749–750.
Walker, N. M., Mandell, K. L., & Tsvat, J. (1999). Use of chart reminders for physicians to promote discussion of advance directives in patients with AIDS. AIDS Care, 11(3), 345–353.
Weissman, J. S., Haas, J. S., Fowler, F. J., Gatsonis, C., Massagil, M. P., & Cleary, P. (1999) The stability of preferences for life—Sustaining care among persons with AIDS in the Boston health study. In J. S. Weissman, J. S. Haas, F. J. Fowler, C. Gatsonis, M. P. Massagil, & P. Cleary (Eds.), Medical decision making 19(1), 16–26.
Littrell, J., Diwan, S., & Bryant, C. J. (1996). Negotiating advance directives for persons with AIDS. Social Work in Health Care, 23(2), 43–65.
Randall Curtis, J., & Patrick, D. L. (1997). Barriers to communication about end of life care in AIDS patients. Journal of General Internal Medicine, 12, 736–741.
Randall Curtis, J., Patrick, D. L., Caldwell, E., Greenlee, H., & Collier, A. C. (1999). The quality of patient-doctor communication about end of life care: A study of patients with advance AIDS and their primary care clinicians. AIDS, 13(19), 1123–1131.
CDC. (2003). Advancing HIV prevention: New strategies for a changing epidemic—United States, 2003. MMWR, 52(15), 329–332.
Aberg, J. A., Kaplan, J. E., Libman, H., Emmanuel, P., Anderson, J. R., Stone, V. E., Oleske, J. M., Currier, J. S., Gallant, J. E. (2009). A primary care guidelines for the management of persons infected with human immunodeficiency virus: 2009 update by the HIV medicine association of the Infectious Diseases Society of America. Clinical Infectious Diseases 49(5), 651–681. http://cid.oxfordjournals.org/content/49/5/651.full. Accessed 27 July 2012.
Freudenhheimp, M. (2001). Price of success in AIDS treatment; Hospitals confront new therapy. New York Times. http://www.nytimes.com/2001/06/07/business/price-of-success-in-aids-treatment-hospitals-confront-new-therapy.html?pagewanted=all&src=pm. Accessed on 6 June 2012.
Rosenfeld, D., Bartlam, B., & Smith, R. D. (2012). Out of the closet and into the trenches: Gay male baby boomers, aging and HIV/AIDS. The Gerontologist, 52(2), 255–264.
Karpiak, S. (2012). An in-depth examination of an emerging population: Who are these older adults living with HIV. http://www.health.ny.gov/diseases/aids/conferences/plenaries/docs/who_are_these_older_adults.pdf. Accessed 30 July 2012.
Sam, P., & Singer, P. (1993). Canadian outpatient and advance directives: Poor knowledge and little experience but positive attitudes. Canadian Medical Association Journal, 148(9), 1497–1502.
Akabayashi, A., Taylor Slingsby, B., Kai, I. (2012) Perspectives on advance directives in Japanese society: A population-based questionnaire survey. BMC Medical Ethics. http://www.biomedcentral.com. Accessed 26 March 2012.
Kim, S. S., Lee, W. H., Cheon, J. Y., Lee, J. E., Yeo, K. S., & Lee, J. H. Preferences for advance directives in Korea. Nursing Research and Practice vol. 2012, Article ID 873892, 7 pages. doi:10.1155/2012/873892. http://www.hindawi.com/journals/nrp/2012/873892/. Accessed 2 August 2012.
Volker, D. L. (2005). Control and end-of-life care: Does ethnicity matter? American Journal of Hospice and Palliative Care, 22(6), 442–446.
Azoulay, E., Pochard, F., Chevret, S., Adrie, C., Bollaert, P. E., Brun, F., et al. (2003). Opinions about surrogate designation: A population survey in France. Critical Care Medicine, 31(6), 1711–1714.
Mitchell, B. L., & Mitchell, L. C. (2009). Review of the literature on cultural competence and end of life treatment decisions: The role of the hospitalist. Journal National Medical Association, 101(9), 920–926.
Volker, D. L. (2005). Control and end-of-life care: Does ethnicity matter? American Journal of Hospice and Palliative Care, 22(6), 442–446.
Shrank, W. H., Kutner, J. S., Richardson, T., Mularski, R. A., Fischer, S., & Kagawa-Singer, M. (2005). Focus group findings about the influence of culture on communication preferences in end of life care. Journal of General Internal Medicine, 20(8), 703–709.
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de Caprariis, P.J., Carballo-Diéguez, A., Thompson, S. et al. Advance Directives and HIV: A Current Trend in the Inner City. J Community Health 38, 409–413 (2013). https://doi.org/10.1007/s10900-012-9645-x
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DOI: https://doi.org/10.1007/s10900-012-9645-x