Ramona L Rhodes1, Fiza Nazir2, Sonya Lopez3, Lei Xuan4, Ank E Nijhawan5, Nicole E Alexander-Scott6, Ethan A Halm7. 1. Division of Geriatric Medicine, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA. Electronic address: Ramona.Rhodes@UTSouthwestern.edu. 2. Division of Geriatric Medicine, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA. 3. Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA. 4. Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas, USA. 5. Division of Infectious Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA. 6. Division of Infectious Diseases, Department of Internal Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA. 7. Division of General Internal Medicine, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA; Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas, USA.
Abstract
CONTEXT: Although highly active antiretroviral therapy has improved survival among many HIV patients, there are still those with advanced illness and limited access to care who may benefit from palliative care and hospice. OBJECTIVES: To examine completion of advance directives, use of palliative care, and enrollment in hospice among HIV patients who receive care at an urban safety net hospital. METHODS: This was a retrospective cohort study of HIV patients in a large, urban safety net hospital in 2010. Physicians abstracted data from the electronic medical record on patient and clinical factors and end-of-life care use. Logistic regression examined predictors of hospice use. RESULTS: Overall, 367 HIV patients identified electronically by International Classification of Disease (ICD)-9 code were hospitalized in 2010. The mean age was 42 years, and 57% were African American. Although 28% died, only 6% of the sample received palliative care consultation, and 6% of the sample enrolled in hospice. Those who received hospice had lower albumin levels (adjusted odds ratio [AOR] 4.53, 95% CI 1.19-17.34) had received palliative care (AOR 9.73, 95% CI 2.10-45.09) and completed an advance directive (AOR 16.33, 95% CI 4.23-61.68). Of those patients who received hospice, the mean time to death after enrollment was 11 days. CONCLUSION: Among an urban cohort of HIV patients, the rates of advance directive completion, palliative care use, and hospice use were low. Despite advancements in the treatment of HIV, many patients with advanced illness may benefit from palliative care and hospice services. Advances should be made in identifying those patients earlier in their disease trajectories.
CONTEXT: Although highly active antiretroviral therapy has improved survival among many HIVpatients, there are still those with advanced illness and limited access to care who may benefit from palliative care and hospice. OBJECTIVES: To examine completion of advance directives, use of palliative care, and enrollment in hospice among HIVpatients who receive care at an urban safety net hospital. METHODS: This was a retrospective cohort study of HIVpatients in a large, urban safety net hospital in 2010. Physicians abstracted data from the electronic medical record on patient and clinical factors and end-of-life care use. Logistic regression examined predictors of hospice use. RESULTS: Overall, 367 HIVpatients identified electronically by International Classification of Disease (ICD)-9 code were hospitalized in 2010. The mean age was 42 years, and 57% were African American. Although 28% died, only 6% of the sample received palliative care consultation, and 6% of the sample enrolled in hospice. Those who received hospice had lower albumin levels (adjusted odds ratio [AOR] 4.53, 95% CI 1.19-17.34) had received palliative care (AOR 9.73, 95% CI 2.10-45.09) and completed an advance directive (AOR 16.33, 95% CI 4.23-61.68). Of those patients who received hospice, the mean time to death after enrollment was 11 days. CONCLUSION: Among an urban cohort of HIVpatients, the rates of advance directive completion, palliative care use, and hospice use were low. Despite advancements in the treatment of HIV, many patients with advanced illness may benefit from palliative care and hospice services. Advances should be made in identifying those patients earlier in their disease trajectories.
Authors: Susan S Reif; Kathryn Whetten; Elena R Wilson; Carolyn McAllaster; Brian W Pence; Sara Legrand; Wenfeng Gong Journal: AIDS Care Date: 2013-08-14
Authors: Frank J Palella; Rose K Baker; Anne C Moorman; Joan S Chmiel; Kathleen C Wood; John T Brooks; Scott D Holmberg Journal: J Acquir Immune Defic Syndr Date: 2006-09 Impact factor: 3.731
Authors: F J Palella; K M Delaney; A C Moorman; M O Loveless; J Fuhrer; G A Satten; D J Aschman; S D Holmberg Journal: N Engl J Med Date: 1998-03-26 Impact factor: 91.245
Authors: Brian A Perry; Andrew O Westfall; Elizabeth Molony; Rodney Tucker; Christine Ritchie; Michael S Saag; Michael J Mugavero; Jessica S Merlin Journal: J Palliat Med Date: 2013-03-11 Impact factor: 2.947
Authors: Margaret T May; Mark Gompels; Valerie Delpech; Kholoud Porter; Chloe Orkin; Stephen Kegg; Phillip Hay; Margaret Johnson; Adrian Palfreeman; Richard Gilson; David Chadwick; Fabiola Martin; Teresa Hill; John Walsh; Frank Post; Martin Fisher; Jonathan Ainsworth; Sophie Jose; Clifford Leen; Mark Nelson; Jane Anderson; Caroline Sabin Journal: AIDS Date: 2014-05-15 Impact factor: 4.177
Authors: Samuel F Freedman; Carrie Johnston; John J Faragon; Eugenia L Siegler; Tessa Del Carmen Journal: Eur Geriatr Med Date: 2018-12-06 Impact factor: 1.710
Authors: Maureen E Lyon; Leah Squires; Rachel K Scott; Debra Benator; Linda Briggs; Isabella Greenberg; Lawrence J D'Angelo; Yao Iris Cheng; Jichuan Wang Journal: AIDS Behav Date: 2020-12
Authors: Claire E Kendall; Mathieu Chalifoux; Doug Manuel; Robert Reinhard; Gregory Robinson; Jean Bacon; Sean B Rourke; Ron Rosenes; Peter Tanuseputro Journal: J Acquir Immune Defic Syndr Date: 2017-05-01 Impact factor: 3.731
Authors: Shelli L Feder; Janet P Tate; Kathleen M Akgün; Julie A Womack; Sangchoon Jeon; Marjorie Funk; Roger J Bedimo; Matthew J Budoff; Adeel A Butt; Kristina Crothers; Nancy S Redeker Journal: Am J Hosp Palliat Care Date: 2018-10-10 Impact factor: 2.500