Communication of preferences for care among human immunodeficiency virus-infected patients. Barriers to informed decisions?
C. Mouton, J. M. Teno, V. Mor and J. Piette
Department of Family Medicine, University of Medicine and Dentistry-New Jersey Medical School, Newark, USA.
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.
