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Communication of Preferences for Care Among Human Immunodeficiency Virus—Infected PatientsBarriers to Informed Decisions?
Charles Mouton, MD;
Joan M. Teno, MD, MS;
Vincent Mor, PhD;
John Piette, PhD
Arch Fam Med. 1997;6(4):342-347.
Abstract
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Objective
To examine the way patients with serious, progressive illnesses communicate their care preferences to their physician.
Design
An observational, cross-sectional survey of 1031 clients with acquired immunodeficiency syndrome (AIDS) or symptomatic human immunodeficiency virus disease. Self-report of communication was assessed in 861 clients who stated a treatment preference focused on extending life or focused on comfort even if it shortened life.
Setting
The Robert Wood Johnson AIDS Health Services Program in 9 US cities.
Participants
Eight hundred sixty-one of 1031 clients recruited to the AIDS Health Services Program.
Results
Eight hundred sixty-one subjects expressed a preferred treatment approach; however, only 35.8% had spoken to their physician about their preferred treatment. Black clients were half as likely (odds ratio, 0.49; confidence interval, 0.29-0.85) to have discussed their preferred treatment approach even after adjustment for age, function, education, income, and other covariates. Black clients were half as likely to prefer an approach to care that focused only on comfort (odds ratio, 0.51; 95% confidence interval, 0.34-0.76). Clients with AIDS who were symptomatic daily, college educated, and more functionally impaired were more likely to have discussed a preferred treatment approach with their physician.
Conclusions
Most persons with symptomatic human immunodeficiency virus infection have not discussed their preferred treatment approach with a physician. This disparity is greater for blacks, who were less likely to want a palliative treatment approach.
Author Affiliations
From the Department of Family Medicine, University of Medicine and Dentistry-New Jersey Medical School, Newark (Dr Mouton); the Center for Evaluative Clinical Sciences, Dartmouth-Hitchcock Medical Center, Hanover, NH (Dr Teno); Brown University Center for Gerontology and Health Care Research, Providence, RI (Dr Mor); and the Institute for Health Policy Studies, University of California, San Francisco (Dr Piette). Dr Mouton is now with the Department of Family Practice, The University of Texas Health Science Center at San Antonio.
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