Delivering More, Better and Earlier Goals of Care Conversations to Seriously Ill Oncology Patients in the Clinical Setting (FR481C)

Abstract

population as it relates to the inpatient and outpatient setting. Brainstorm how providers across multiple disciplines can work together to provide effective ACP in the HIV-infected population. Systematic Review Background. Since the advent of antiretroviral therapy (ART), HIV has transitioned from a rapidly fatal illness to a chronic disease with multi-morbidity, and providers are faced with an emerging population with unique advance care planning (ACP) needs. Aims. To provide a narrative review of existing studies on ACP in adult HIV-infected patients in the post-ART era. Session descriptions. Original studies describing ACP for adult HIV-infected patients post-ART (1996-present) were identified through searches of PUBMED, EMBASE and PsychINFO, excluding nonEnglish and legal/social work articles. Nine studies met the selection criteria. They were conducted between 1996 and 2013, with study size ranging from 47 to 2864 patients. Most studies consisted of young, white, male patients with less than college education in the outpatient setting, and they had poorly defined definitions of ACP. The prevalence of ACP was variable (36-54% end-of-life communication, 847% advance directive). Lack of ACP was most commonly associated with less severity of illness, followed by non-white race, drug use, younger age, female sex, low education, low income, and social isolation. Providers reported limited time/energy and inadequate preparation/training as barriers to ACP. Conclusion. Existing literature on ACP in the postART era is limited. The prevalence of ACP in HIVinfected patients is low in vulnerable subgroups (non-white race, drug users, those of lower socioeconomic status, socially-isolated patients), but higher with increased age, severity of illness, or multimorbidity. Providers also report logistics and inadequate preparation as barriers to ACP. More research is needed to effectively increase ACP among HIV-infected patients.