Advance Care Planning among Midlife and Older Adult Sexual Minority Men

中年和老年性少数男性的预先护理计划

• 批准号: 10179295
• 负责人: Daniel Siconolfi
• 金额: $ 9.06万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-15 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10179295
• 关键词: Address; Advance Care Planning; Advance Directives; American; Attention; Behavior; Belief; Bereavement; Bisexual; Caring; Clinical; Cognitive; Cohort Studies; Data; Data Analyses; Decision Making; Development; Dimensions; Discrimination; Documentation; Elderly; Epidemic; Ethnic Origin; Family; Family health status; Foundations; Future; Gays; General Population; Goals; HIV; HIV Seronegativity; HIV Seropositivity; Health; Health Status; Healthcare; Healthcare Systems; Impairment; Individual; Intervention; Knowledge; Legal; Lesbian; Lesbian Gay Bisexual Transgender; Life; Life Experience; Literature; Longitudinal Studies; Medical; Modeling; Pain; Patient-Centered Care; Patients; Peer Review; Persons; Policies; Population; Prevalence; Proxy; Psychosocial Factor; Publications; Quality of Care; Race; Research; Research Infrastructure; Research Methodology; Role; Services; Sexual and Gender Minorities; Social support; Socioeconomic Status; Statistical Methods; Structure; Testing; The Multicenter AIDS Cohort Study; Time; caregiving; cost; design; end of life; end of life care; ethnic minority population; health care availability; health care settings; improved; low socioeconomic status; male health; men; men who have sex with men; middle age; novel; preference; racial minority; sexual minority; sociodemographic group; sociodemographics; transgender; two-dimensional

Project Summary. In times of serious illness or at the end of life, many Americans receive unwanted care, including life- prolonging and painful interventions, and die in institutional settings. Advance care planning (ACP) permits individuals to communicate their preferences should they become unable to make decisions regarding their own medical care due to physical, cognitive, and/or communicative impairments. ACP improves the concordance between persons’ wishes and the care they receive, and increasing the utilization of ACP can yield benefits to patients, kin and families, and the health care system. Very little is known regarding ACP disparities and predictors among midlife and older adult gay, bisexual, and other men who have sex with men (GBMSM). Existing ACP research has numerous gaps, and GBMSM have distinct life experiences that limit generalizing from existing data regarding ACP behaviors in the general population. It is not known whether there are disparities in ACP across sociodemographic groups such as race, ethnicity, and socioeconomic status among GBMSM. There is also a need to identify psychosocial factors that may influence ACP behaviors among GBMSM. This research will examine formal and informal dimensions of two ACP behaviors (health care proxy, advance directives) using secondary data analyses from the Multicenter AIDS Cohort Study, a longitudinal study of GBMSM with extensive data on sociodemographics, health and health care, and psychosocial factors. The specific aims are to 1) Describe the types and extent of advance care planning (ACP) among midlife and older adult GBMSM, and assess potential disparities across sociodemographic groups; 2) Assess differences in the prevalence of ACP across longitudinal health indicators, and longitudinal health care access and utilization; and 3) Test associations between psychosocial factors and ACP, and whether these associations differ across HIV serostatus groups. This research is critical to understanding ACP among older GBMSM, developing culturally-appropriate models of ACP, and addressing within-group disparities. Improving rates of ACP among GBMSM supports high quality care that is concordant with patients’ wishes during severe illness or at the end of life. These findings will also move the broader field of ACP research forward by virtue of examining factors that are understudied in ACP research more generally (e.g., psychosocial factors).

项目摘要。 在患重病或临终时，许多美国人接受不必要的护理，包括生命- 长期且痛苦的干预措施，并在预先护理计划 (ACP) 允许的机构环境中死亡。 如果个人无法就自己的决定做出决定，则可以表达自己的偏好 由于身体、认知和/或交流障碍而自行接受医疗护理可改善病情。 人们的愿望和他们接受的护理之间的一致性，并增加 ACP 的利用率可以 为患者、亲属和家庭以及医疗保健系统带来好处，人们对 ACP 知之甚少。 中年和老年人同性恋、双性恋和其他男男性行为者之间的差异和预测因素 (GBMSM) 现有的 ACP 研究存在许多差距，并且 GBMSM 具有独特的生活经历限制。 尚不清楚是否从有关一般人群中 ACP 行为的现有数据中得出结论。 不同社会人口群体（如种族、族裔和社会经济地位）的 ACP 存在差异 GBMSM 中的状况 还需要确定可能影响 ACP 行为的社会心理因素。 本研究将考察两种 ACP 行为的正式和非正式维度（医疗保健） 代理、预先指示）使用多中心艾滋病队列研究的二次数据分析， GBMSM 的纵向研究，涉及社会人口统计学、健康和保健方面的大量数据，以及 社会心理因素的具体目标是 1) 描述预先护理计划的类型和范围。 (ACP) 中年和老年 GBMSM 之间的关系，并评估不同社会人口统计学的潜在差异 2) 评估不同纵向健康指标和纵向 ACP 患病率的差异 医疗保健的获取和利用；以及 3) 测试心理社会因素与 ACP 之间的关联，以及 这些关联在不同 HIV 血清状态组中是否存在差异 这项研究对于了解 ACP 至关重要。 在较老的 GBMSM 中，在文化上开发适合 ACP 的模型，并解决群体内的问题 GBMSM 中 ACP 率的提高支持与患者的情况相一致的高质量护理。 这些发现也将推动 ACP 更广泛的领域发展。 通过检查更广泛的 ACP 研究中未充分研究的因素（例如， 心理社会因素）。