Cox PH, Martin MA, Beck CK; International Conference on AIDS.

Int Conf AIDS. 1996 Jul 7-12; 11: 431 (abstract no. Th.D.5178).

Harbor-UCLA Medical Center, Torrance, CA, USA. Fax: (310) 533-0447. E-mail: Cox@Harbor2.humc.edu.

Objective: To determine the relationship of outpatient terminal care discussions (TCD) to place-of-death and choice for hospice services for patients with AIDS. Methods: A retrospective chart review of all HIV+ patients who died while followed in a public hospital clinic in Los Angeles County during an 8 year period ('86-'94) was conducted. Subsequently, 411 patients who died from the complications of AIDS were selected for analysis. All subjects were followed for at least 3 months. Results: Fifty-eight per cent of the charts had documentation of discussion of terminal care issues between the health care provider and patient, which included resuscitation issues, completion of a Durable Power of Attorney for Health Care, and counseling about terminal care and place of death options. Sixty-one per cent of all patients died in hospice facilities (HOF) or at home with home hospice (HH) services. The remainder either died in the hospital (33%) or at home without the benefit of hospice services(6%). Of the patients who died in an HOF or with HH services, 78% had documentation of outpatient TCD. Conversely, only 27% of those who died in hospitals or at home without hospice services had outpatient TCD documented. Patients with MAC (82%; odds ratio 4.40; p= 0.0000003), ADC (78%; 2.84; p= 0.006) and CMV (74%; 2.41; p= 0.0015) were the mostly to have documentation of outpatient TCD. In addition, the greater the number of AIDS defining illnesses (ADI), the greater the likelihood of having outpatient TCD (p= 0.00001). Conclusions: Outpatient terminal care discussions (TCD) have a strong relationship with choice for hospice services by patients with AIDS. Routine incorporation of outpatient TCD in the longitudinal care of these patients is recommended. Guidelines for the initiation and content of these discussions warrant further study and elucidation.

Publication Types:

• Meeting Abstracts

Keywords:

• Acquired Immunodeficiency Syndrome
• Ambulatory Care
• Counseling
• Death
• Delivery of Health Care
• HIV Infections
• Hospice Care
• Hospices
• Humans
• Los Angeles
• Odds Ratio
• Terminal Care
• methods

Other ID:

• 96925424

UI: 102221323

From Meeting Abstracts