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: 10012147
• 负责人: Daniel Siconolfi
• 金额: $ 8.54万
• 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 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10012147
• 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。 在严重疾病的时期或生命的尽头，许多美国人接受了不必要的护理，包括生活 - 延长和痛苦的干预措施，并在机构环境中死亡。预先护理计划（ACP）许可证 如果他们无法就自己的决定做出决定，可以传达他们的偏好 由于身体，认知和/或传达障碍，因此拥有医疗服务。 ACP改善了 人们的愿望与他们所接受的关怀之间的一致性，并增加ACP的利用率 对患者，亲属和家庭以及医疗保健系统的收益益处。关于ACP知之甚少 中年和老年同性恋，双性恋以及其他与男人发生性关系的男人的差异和预测因素 （GBMSM）。现有的ACP研究有许多差距，GBMSM具有限制的独特生活经验 从有关一般人群中有关ACP行为的现有数据中概括。不知道是否 社会人口统计学群体（例如种族，种族和社会经济）的ACP存在差异 GBMSM中的状态。还需要识别可能影响ACP行为的社会心理因素 在GBMSM中。这项研究将检查两种ACP行为（医疗保健）的正式和非正式维度 代理，预先指令）使用来自多中心艾滋病队列研究的辅助数据分析， GBMSM的纵向研究，具有有关社会人口统计学，健康和医疗保健以及 社会心理因素。具体目的是1）描述预先护理计划的类型和程度 （ACP）在中年和老年人GBMSM中，并评估社会人口统计学的潜在差异 群体； 2）评估纵向健康指标和纵向的ACP患病率的差异 医疗保健访问和利用； 3）心理社会因素与ACP之间的测试关联，以及 这些关联是否在HIV血清群中是否有所不同。这项研究对于理解ACP至关重要 在较旧的GBMSM中 差异。 GBMSM中提高ACP的比率支持与患者一致的高质量护理 在严重疾病或生命末期的愿望。这些发现也将移动更广泛的ACP领域 通过检查ACP研究中更广泛地了解的因素的研究（例如， 社会心理因素）。