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Advance Care Planning and HIV Symptoms in Adolescence.

ABSTRACT: OBJECTIVES:To determine the effect of family-centered pediatric advance care planning (FACE pACP) on HIV-specific symptoms. METHODS:In this single-blinded, randomized controlled trial conducted at 6 US hospital-based HIV clinics, 105 adolescent-family dyads, randomly assigned from July 2011 to June 2014, received 3 weekly sessions in either the FACE pACP arm ([1] pediatric advance care planning survey, [2] Respecting Choices interview, and [3] 5 Wishes directive) or the control arm ([1] developmental history, [2] safety tips, and [3] nutrition and exercise tips). The General Health Assessment for Children measured patient-reported HIV-specific symptoms. Latent class analyses clustered individual patients based on symptom patterns. Path analysis examined the mediating role of dyadic treatment congruence with respect to the intervention effect on symptom patterns. RESULTS:Patients were a mean age of 17.8 years old, 54% male, and 93% African American. Latent class analysis identified 2 latent HIV-symptom classes at 12 months: higher symptoms and suffering (27%) and lower symptoms and suffering (73%). FACE pACP had a positive effect on dyadic treatment congruence (? = .65; 95% CI: 0.04 to 1.28), and higher treatment congruence had a negative effect on symptoms and suffering (? = -1.14; 95% CI: -2.55 to -0.24). Therefore, FACE pACP decreased the likelihood of symptoms and suffering through better dyadic treatment congruence (? = -.69; 95% CI: -2.14 to -0.006). Higher religiousness (? = 2.19; 95% CI: 0.22 to 4.70) predicted symptoms and suffering. CONCLUSIONS:FACE pACP increased and maintained agreement about goals of care longitudinally, which lowered adolescents' physical symptoms and suffering, suggesting that early pACP is worthwhile.

SUBMITTER: Lyon ME

PROVIDER: S-EPMC6317555 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

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Advance Care Planning and HIV Symptoms in Adolescence.

Lyon Maureen E ME Garvie Patricia A PA D'Angelo Lawrence J LJ Dallas Ronald H RH Briggs Linda L Flynn Patricia M PM Garcia Ana A Cheng Yao I YI Wang Jichuan J

Pediatrics 20181019 5

<h4>Objectives</h4>To determine the effect of family-centered pediatric advance care planning (FACE pACP) on HIV-specific symptoms.<h4>Methods</h4>In this single-blinded, randomized controlled trial conducted at 6 US hospital-based HIV clinics, 105 adolescent-family dyads, randomly assigned from July 2011 to June 2014, received 3 weekly sessions in either the FACE pACP arm ([1] pediatric advance care planning survey, [2] Respecting Choices interview, and [3] 5 Wishes directive) or the control ar ...[more]

PMID: 30341154

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Project description:Background/objectiveAdvance care planning (ACP) is associated with improved patient and caregiver outcomes, but is underutilized. To encourage ACP, the Centers for Medicare & Medicaid Services implemented specific ACP visit reimbursement codes in 2016. To better understand the utilization of these ACP reimbursement codes, we explored regional variation in billed ACP visits.DesignWe performed a retrospective cross-sectional analysis using a randomly sampled 5% cohort of Medicare fee-for-service (FFS) beneficiaries' claims files from 2017. Region was defined by hospital referral region.SettingNational Medicare FFS.ParticipantsA total of 1.3 million Medicare beneficiaries aged 65 years and older.MeasurementReceipt of billed ACP service, identified through Current Procedural Terminology code 99497 or 99498. Proportion of beneficiaries who received billed ACP service(s) by region was calculated. We fit a multilevel logistic regression model with a random regional intercept to determine the variation in billed ACP visits attributable to the region after accounting for patient (demographics, comorbidities, and medical care utilization) and regional factors (hospital size, emergency department visits, hospice utilization, and costs).ResultsThe study population included about 1.3 million beneficiaries, of which 32,137 (2.4%) had at least one billed ACP visit in 2017. There was substantial regional variation in the percentage of beneficiaries with billed ACP visits: lowest quintile region, less than 0.83%; subsequent regions, less than 1.6%, less than 2.4%, less than 3.3% to less than 8.4% in the highest quintile regions. A total of 15.4% of the variance in whether an older adult had a billed ACP visit was explained by the region. Although numerous regional factors were associated with billed ACP visits, none were strong predictors.ConclusionIn 2017, we found wide regional variation in the use of billed ACP visits, although use overall was low in all regions. Increasing the understanding of the drivers and the effects of billed ACP visits could inform strategies for increasing ACP.

Dataset Information

Advance Care Planning and HIV Symptoms in Adolescence.

Publications

Advance Care Planning and HIV Symptoms in Adolescence.

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