Internal Medicine, Palliative Medicine Program, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
J Pain Symptom Manage. 2019 Dec;58(6):1040-1047. doi: 10.1016/j.jpainsymman.2019.08.019. Epub 2019 Aug 22.
Little attention has been given to social environmental factors associated with advance care planning (ACP) among African Americans or people living with advanced HIV (PLHIV).
The present study aimed to identify support network factors that affect the likelihood of naming a decision-maker and of talking to family/friends and doctors about ACP among vulnerable PLHIV.
PLHIV were recruited from a large urban HIV clinic. A social support network inventory was used to calculate number of persons available for various types of support. Characteristics of network members were also collected. Multivariable logistic regression models were fit to examine associations between social network factors and ACP discussion, adjusting for age, sex, education, and total number of network members.
The sample (N = 370) was mostly African American (95%), male (56%), and 48% had less than a high school education. Almost half the sample (48%) had talked to their family/friends or doctor about ACP, and 34% had named a medical decision-maker. Adjusted analysis revealed that talking about ACP with family/friends was associated with female sex and a larger closer support network who provided health information and physical assistance. Talking to doctors about ACP was associated with larger support networks who provided physical assistance but lower numbers from whom emotional support was received. Naming a decision-maker was associated with greater numbers of network members who provided emotional support, health information, and medication adherence reminders.
The findings revealed aspects of family/support network structures and caregiving function associated with ACP in a population with often vital yet vulnerable networks.
针对非裔美国人和晚期 HIV 感染者（PLHIV）的预先医疗护理计划（ACP），相关社会环境因素很少受到关注。
本研究旨在确定支持网络因素，以了解在高危 PLHIV 中，哪些因素会影响其指定决策者的可能性，以及与家人/朋友和医生讨论 ACP 的可能性。
从一家大型城市 HIV 诊所招募 PLHIV。使用社会支持网络清单来计算各种类型支持的可获得人数。还收集了网络成员的特征。使用多变量逻辑回归模型，根据年龄、性别、教育程度和网络成员总数，调整模型以检验社会网络因素与 ACP 讨论之间的关联。
样本（N=370）主要为非裔美国人（95%），男性（56%），其中 48%的人受教育程度低于高中。近一半的样本（48%）曾与家人/朋友或医生讨论过 ACP，34%的人指定了医疗决策人。调整分析显示，与家人/朋友讨论 ACP 与女性性别和更亲近、更紧密的支持网络有关，该网络提供健康信息和身体援助。与医生讨论 ACP 与提供身体援助的更大支持网络有关，但从他们那里获得情感支持的人数较少。指定决策人则与提供情感支持、健康信息和药物依从性提醒的网络成员人数较多有关。
这些发现揭示了与具有重要作用但脆弱的网络相关的家庭/支持网络结构和照护功能的 ACP 方面。
