| Learning Objective #1: Describe research findings about advance directives for people with HIV/AIDS | |||
| Learning Objective #2: List three specific strategies to improve clinical practice around advance directives for people with HIV/AIDS |
Abstract: Advance directives (ADs) are a means for expressing wishes about medical care at the end of life. ADs include proxy directives such as a health care proxy or durable power of attorney for health care, and treatment directives such as living wills. The benefits of ADs have been demonstrated and include embracing and ensuring individual autonomy, enabling proactive participation in decisions about health care at the end of life, and decreasing family stress by alleviating decision-making burdens for loved ones.
It is important to understand the impact of ADs in the specific context of HIV/AIDS. Infection with HIV remains, for many people, a chronic and progressive illness despite significant advances in HIV pharmacotherapeutics. Furthermore, a significant proportion of people with newly diagnosed HIV infection already have advanced infection or AIDS at the time of diagnosis. In addition, many HIV-positive gay and lesbian patients, if asked, would not choose close relatives to be surrogate decision makers.
Findings: Research on ADs for people with HIV/AIDS includes: AD completion rates, interventions to increase completion rates, treatment preferences, barriers and facilitators of making ADs, HIV-specific treatment directives, and living and dying with HIV/AIDS. Few researchers have linked these findings with patient/family/clinician discussions; the process of how patients go about making AD decisions; and how to make these activities occur in a timely and meaningful way, that is, prior to the time when a patient is hospitalized with serious illness or can no longer participate in such discussions.
Practice Recommendations: Needs identified are: developing clinical practices/interventions to increase completion of ADs; strengthening clinician comfort and confidence, thereby enhancing AD discussions with patients with HIV/AIDS; attending to cultural diversity and differences related to non-traditional relationships; and refining HIV-specific treatment directives.
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