Doctor-patient concordance during HIV treatment switching decision-making

Clucas, Claudine; Harding, Richard; Lampe, Fiona; Anderson, Jane; Date, Heather Leake; Johnson, Margaret; Edwards, Simon; Fisher, Martin; Sherr, Lorraine

doi:10.1111/j.1468-1293.2010.00851.x

Cited by 39 publications

(28 citation statements)

References 37 publications

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“…There is also evidence that symptom management improves virologic suppression and adherence [42, 43, 22]. Therefore, understanding risk factors for pain and symptoms is an important part of improving outcomes in patients with HIV.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Pain and Physical and Psychological Symptoms in Ambulatory HIV Patients in the Current Treatment Era

Merlin

Cen

Praestgaard

et al. 2012

Journal of Pain and Symptom Management

121

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Context HIV infection has become a manageable chronic disease. There are few studies of pain and symptoms in the current treatment era. Objectives The primary objective was to determine the prevalence of and risk factors for pain and physical and psychological symptoms in a population of ambulatory HIV patients. Methods We performed a cross-sectional study using the Brief Pain Inventory and the Memorial Symptom Assessment Scale. Results We evaluated 156 individuals with a median age of 47.5 years (range 21–71), median time since HIV diagnosis of 11 years (range <1–25), and median CD4+ cell count of 502 cells/mm3 (interquartile range [IQR] 308–683). The majority (125, 80.6%) had an undetectable viral load. Seventy-six (48.7%) reported pain, of whom 39 (51.3%) had moderate to severe pain, and 43 (57.3%) had pain that caused moderate to severe interference with their lives. The median number of symptoms was eight (IQR 5–14.5) of 32 queried. In multivariable analyses, patients with psychiatric illness were 39.8% more likely to have pain (P<0.001). Psychiatric illness was associated with 0.7 and 1.2 point higher MSAS subscale scores, and intravenous (IV) drug use was associated with 0.4 and 0.5 higher subscale scores (out of four). Conclusion Pain and other physical and psychological symptoms were common among ambulatory HIV patients. Pain and symptoms were strongly associated with psychiatric illness and IV drug use. Future investigation should evaluate interventions that include psychiatric and substance abuse components for HIV patients with pain.

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Section: Discussionmentioning

confidence: 99%

“…We assessed other physical and psychological symptoms using the Memorial Symptom Assessment Scale Short Form (MSAS), which has been used in patients with and without cancer, including those with HIV [21, 22]. The MSAS asks patients to report whether they have had any of 26 physical symptoms and 6 psychological symptoms over the past week.…”

Section: Methodsmentioning

confidence: 99%

Pain and Physical and Psychological Symptoms in Ambulatory HIV Patients in the Current Treatment Era

Merlin

Cen

Praestgaard

et al. 2012

Journal of Pain and Symptom Management

121

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“…Treatment success has been described as the shared responsibility of providers and patients (Burns & Vermund, 2010), resulting, in part, from the efforts of both patients and providers to enable the patient to achieve and maintain adherence (Thrun et al, 2009). Communication between patients and providers may be a critical component in facilitating the therapeutic relationship (Beach, Keruly, & Moore, 2006; Clucas et al, 2011; Schneider, Kaplan, Greenfield, Li, & Wilson, 2004). Increased social support by medical professionals, friends, family members have been found to improve adherence to HIV medication and linked to quality of life for patients living with HIV; (Ncama et al, 2008; Peltzer, Friend-du Preez, Ramlagan, & Anderson, 2010; Reilly & Woo, 2004), while a lack of familial and social support have been demonstrated to be a barrier to care (Nachega et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

Patient–provider perceptions on engagement in HIV care in Argentina

et al. 2013

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Approximately 30% of patients participating in the national antiretroviral therapy (ART) program in Argentina fail to achieve an undetectable viral load, and approximately 25% are not retained in care. This qualitative study was designed to explore and identify factors associated with engagement and retention in public and private health care in Buenos Aires, Argentina. Qualitative data from key informants (n = 12) and focus groups (n = 4 groups) of patients and providers from private and public HIV treatment facilities were recorded and transcribed. Predetermined and arising themes related to adherence, engagement, and retention in care were coded and analyzed using qualitative data analysis software. Reasons identified for patients’ lack of adherence or engagement in care differed between patients and providers, and patients attributed limitations to low self-efficacy, fear and concerns about HIV, and lack of provider involvement in treatment. In contrast, providers viewed themselves as decision-makers in patient care and patients as responsible for their own nonadherence due to lack of commitment to their own health or due to medication side effects. Patients reported health care system limitations and HIV concerns contributed to a lack of engagement, and providers identified limited HIV literacy and stigma as additional problems. Both agreed that chronic illness and substance addiction impacted adherence and retention, and agreed on the importance of trust, honesty, and communication in the patient–provider relationship. Results support the incorporation of system-, provider-, and patient-focused components into interventions to facilitate patient engagement, adherence, and retention in public and private settings in Argentina.

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“…Communication styles that improve patient engagement, build rapport, and shared decision-making are critical components of effective interpersonal care. In HIV care, the quality of patient–provider communication affects medical adherence, virologic outcomes, and overall patient health (Beach, Keruly, & Moore, 2006; Clucas et al, 2011; Schneider, Kaplan, Greenfield, Li, & Wilson, 2004). …”

Section: Introductionmentioning

confidence: 99%

The impact of depressive symptoms on patient–provider communication in HIV care

et al. 2013

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Persons with HIV who develop depression have worse medical adherence and outcomes. Poor patient–provider communication may play a role in these outcomes. This cross-sectional study evaluated the influence of patient depression on the quality of patient–provider communication. Patient–provider visits (n = 406) at four HIV care sites were audio-recorded and coded with the Roter Interaction Analysis System (RIAS). Negative binomial and linear regressions using generalized estimating equations tested the association of depressive symptoms, as measured by the Center for Epidemiology Studies Depression scale (CES-D), with RIAS measures and postvisit patient-rated quality of care and provider-reported regard for his or her patient. The patients, averaged 45 years of age (range = 20–77), were predominately male (n = 286, 68.5%), of black race (n = 250, 60%), and on antiretroviral medications (n = 334, 80%). Women had greater mean CES-D depression scores (12.0) than men (10.6; p = 0.03). There were no age, race, or education differences in depression scores. Visits with patients reporting severe depressive symptoms compared to those reporting none/mild depressive symptoms were longer and speech speed was slower. Patients with severe depressive symptoms did more emotional rapport building but less social rapport building, and their providers did more data gathering/counseling (ps < 0.05). In postvisit questionnaires, providers reported lower levels of positive regard for, and rated more negatively patients reporting more depressive symptoms (p < 0.01). In turn, patients reporting more depressive symptoms felt less respected and were less likely to report that their provider knows them as a person than none/mild depressive symptoms patients (ps < 0.05). Greater psychosocial needs of patients presenting with depressive symptoms and limited time/resources to address these needs may partially contribute to providers’ negative attitudes regarding their patients with depressive symptoms. These negative attitudes may ultimately serve to adversely impact patient–provider communication and quality of HIV care.

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Doctor-patient concordance during HIV treatment switching decision-making

Cited by 39 publications

References 37 publications

Pain and Physical and Psychological Symptoms in Ambulatory HIV Patients in the Current Treatment Era

Pain and Physical and Psychological Symptoms in Ambulatory HIV Patients in the Current Treatment Era

Patient–provider perceptions on engagement in HIV care in Argentina

The impact of depressive symptoms on patient–provider communication in HIV care

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