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15-09-2018

Quality of life of persons living with HIV and congruence with surrogate decision-makers

Tijdschrift:
Quality of Life Research
Auteurs:
Katherine B. Curtin, Yao I. Cheng, Jichuan Wang, Rachel K. Scott, Leah Squires, Debra A. Benator, Maureen E. Lyon, for the Palliative Care Consortiums
Belangrijke opmerkingen
Data presented previously in abstract form at the 2016 Annual Conference for the Society of Clinical Research Associates in Montreal, Canada and the 2017 Advance Care Planning and End of Life Care Annual Conference in Alberta, Canada. Data have not been published previously.
Our study sites were: Children’s National Health System, MedStar Health Research Institute/Washington Hospital Center, MedStar Georgetown University Hospital, The George Washington Medical Faculty Associates and the Washington DC Veterans Affairs Medical Center/Institute for Clinical Research, Inc.

Abstract

Purpose

Physicians and caregivers rate patient quality of life (QOL) lower than patients rate their own QOL. This study investigated discrepancies between self-assessments of patient QOL by adults with HIV and their surrogate decision-makers.

Methods

We collected baseline data from 223 adult dyads in the FAmily-CEntered (FACE) Advance Care Planning (ACP) clinical trial, consisting of HIV positive patients and their chosen surrogates. Participants independently completed the Medical Outcome Study-HIV Survey (MOS-HIV) and the Palliative care Outcome Scale (POS). We used Wilcoxon Signed-Rank Test to assess differences in overall patient–surrogate means. We used Prevalence Adjusted Bias Adjusted Kappa (PABAK) statistics to assess dyadic agreement, with surrogate HIV status and cohabitation status as grouping variables.

Results

Patients were 56.1% male, 86.1% Black/African-American, aged 22–77 (mean = 50.83, SD = ± 12.33). Surrogates were 43.8% male, 84.1% Black/African-American, aged 18–82 (mean = 49.73, SD = ± 14.22). 46.2% of surrogates lived with the patient. 64.6% of surrogates reported negative HIV status. Surrogates were more likely to state patients were ill, p = 0.032. Among patient–surrogate dyads, most QOL assessments showed poor (0.00–0.39) or fair (0.40–0.59) agreement and agreement tended to be even poorer among patient–surrogate dyads where the surrogate had a shared HIV diagnosis.

Conclusions

QOL discrepancies are said to arise from healthy surrogates overestimating the effects of chronic illness. In this novel assessment, many surrogates had a shared HIV diagnosis, without increased agreement. These findings highlight the challenge of accurately assessing patient QOL by surrogates, even when there is a shared HIV diagnosis. Improved communication is needed between patients and surrogates about the patients’ representation of illness.
National Clinical Trial Number: NCT01775436.

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