The HIV-specific advance directive

Abstract

Objective: To determine whether persons living with HIV find a disease-specific advance directive more acceptable than a generic directive.

Design: Randomized clinical trial.

Setting: HIV consumer organization and hospital-based HIV clinic.

Participants: Volunteer sample of persons with HIV.

Interventions: The disease-specific HIV Living Will, the generic Centre for Bioethics Living Will, or both.

Measurements and main results: Of 101 participants who received both advance directives, 78 (77.2%) preferred the disease-specific HIV Living Will and 23 (22.8%) preferred the generic Centre for Bioethics Living Will (p < .001). Most participants who preferred the HIV Living Will did so because it was more specific or relevant to their situation.

Conclusions: Persons living with HIV prefer a disease-specific to a generic advance directive. They should be offered a disease-specific advance directive. Our findings should also encourage investigators to develop and evaluate disease-specific advance directives in other clinical settings.

Figures

Treatment preferences on the Centre for Bioethics Living Will. The height of each bar represents the proportion of participants at the second interview who wanted the specified treatment in the specified health situation. The number of participants answering for each situation-treatment choice ranges from 61 to 63. The health states are indicated along the x axis; within each health state, the bars (from left to right) represent cardiopulmonary resuscitation, ventilator, dialysis, surgery, blood transfusion, antibiotics, and tube feeding.

Treatment preferences on the HIV Living Will. The height of each bar represents the proportion of participants at the second interview who wanted the specified treatment in the specified health situation. The number of participants answering each situation-treatment choice ranges from 108 to 114. The health states are indicated along the x axis; within each health state, the bars (from left to right) represent cardiopulmonary resuscitation, antibiotics, ventilator, surgery, blood transfusion, and tube feeding.