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301384
Preferences for Formal vs. Informal Care: Predictors of End of Life Care among Persons with HIV/AIDS
Sunday, November 16, 2014
Mary Mitchell, PhD
,
Dept of Health, Behavior, and Society, Johns Hopkins University, Baltimore, MD
Thomas Smith, MD, FACP, FASCO
,
Johns Hopkins Medical Institutions, Baltimore, MD
Amy Knowlton, MPH, ScD
,
Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Background: Due to advancements in antiretroviral therapies, persons living with HIV/AIDS (PLHAs) are living longer and with increased care needs. The objectives of this study were to assess: (1) whether vulnerable PLHAs preferred informal versus professional care; and (2) factors associated with their end of life preference. Methods: Data were from the Being Active and Connected study, which examined social factors related to health outcomes among PLHAs. Structural equation modeling was used to identify individual and network characteristics associated with PLHAs’ care preferences at end of life. Results: Nearly half of respondents (47%) indicated a preference for informal care (N=383). Predictors of family care preference included: female sex (standardized coefficient [Std. Coef.] = .12, p<.05); having a main partner as their caregiver (Std. Coef. = .14, p<.05); receiving health assistance from social network members (Std. Coef. = .22, p< .001); having more social network members who felt it was important to take HIV medications (Std. Coef. = .23, p<.001); and having more female kin in their support network (Std. Coef. = .23, p<.001). Not wanting to owe favors to anyone was negatively associated with family care preference (Std. Coef. = -.26, p<.001). Conclusions: Given PLHAs' substantial need for familial care, our results suggest that support is needed for end of life informal caregivers. Interventions should bolster caregivers' coping skills and connection to support programs. Inclusion of informal caregivers in collaborative treatment decision making can reduce early caregiving cessation and improve health outcomes in a vulnerable population with less preference and/or means for professional care.
Learning Areas:
Assessment of individual and community needs for health education
Planning of health education strategies, interventions, and programs
Provision of health care to the public
Public health or related research
Social and behavioral sciences
Learning Objectives:
Assess whether vulnerable persons living with HIV/AIDS preferred informal versus professional care
Identify individual and support network factors associated with preference for informal care
Keyword(s): HIV/AIDS, End-of-Life Care
Presenting author's disclosure statement:Qualified on the content I am responsible for because: I have been responsible for planning, implementing, and evaluating grant-funded interventions in low-income communities. My master’s thesis identified predictors of engagement in health promotion among African-American churches, and I was simultaneously an adjunct lecturer in research methodology for a Bachelor of Health Science Program. As a Brown Scholar at Johns Hopkins University, I am focusing my dissertation on identifying predictors of medical adherence among HIV-positive injection drug users.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines,
and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed
in my presentation.
