Overcoming the False Dichotomy of Curative vs Palliative Care for Late-Stage HIV/AIDS

Selwyn, Peter A.; Forstein, Marshall

doi:10.1001/jama.290.6.806

Cited by 66 publications

(41 citation statements)

References 58 publications

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“…As HIV infection in the industrialized world has evolved into 'a manageable chronic illness' (Selwyn & Forstein, 2003), greater attention is now focused on the significant proportion of persons living with HIV infection (PLWH) who present to care with co-occurring substance abuse disorders and mental disorders. Based on a nationally representative probability sample, Bing et al (2001) found that half of adults receiving HIV care in the USA presented with psychiatric disorders, and 42% reported using drugs other than marijuana.…”

Section: Introductionmentioning

confidence: 99%

Literature on integrated HIV care: a review

et al. 2004

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With a significant proportion of HIV-infected patients now presenting with co-occurring substance abuse disorders and mental disorders, interest in integrated HIV care is growing. However, no review of integrated HIV care has been conducted. Using relevant key word searches of the Medline and Psychlit databases, the authors identified about 450 publications. The few evaluations of integrated models tended to focus on measurements of engagement and retention in medical care, and their findings indicated an association between integrated HIV care and increased service utilization. No random assignment controlled studies were identified, except in the peripheral area of integrated care (without HIV primary care) for persons with co-occurring substance abuse disorders and mental disorders. The majority of reviewed articles described integrated models operating in the field and various aspects of implementation and sustainability. Overall, they supported use of a wide range of primary and ancillary services delivered by a multidisciplinary team that employs a 'biopsychosocial' approach. Despite the lack of scientific knowledge regarding the effects of integrated HIV care, those wanting to optimize treatment for patients with multiple interacting disorders can gain useful and practical knowledge from this literature.

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Section: Introductionmentioning

confidence: 99%

Literature on integrated HIV care: a review

et al. 2004

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“…[7][8][9] Patients need to form realistic beliefs about their future quality of life to make decisions ranging from whether to undergo screening to whether to pursue aggressive treatment at the end of life. [10][11][12] Beyond the clinic, the difficulties people have predicting their future well-being also appear to contribute to a wide range of faltering public health initiatives ranging from long-term disease prevention 13,14 to advance directives. 15 Current models of shared medical decision-making presuppose a division of labor in which doctors are experts about the medical facts and patients supply values or preferences regarding outcomes.…”

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confidence: 99%

Affective Forecasting: An Unrecognized Challenge in Making Serious Health Decisions

2008

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Patients facing medical decisions that will impact quality of life make assumptions about how they will adjust emotionally to living with health declines and disability. Despite abundant research on decision-making, we have no direct research on how accurately patients envision their future well-being and how this influences their decisions. Outside medicine, psychological research on "affective forecasting" consistently shows that people poorly predict their future ability to adapt to adversity. This finding is important for medicine, since many serious health decisions hinge on quality-of-life judgments. We describe three specific mechanisms for affective forecasting errors that may influence health decisions: focalism, in which people focus more on what will change than on what will stay the same; immune neglect, in which they fail to envision how their own coping skills will lessen their unhappiness; and failure to predict adaptation, in which people fail to envision shifts in what they value. We discuss emotional and social factors that interact with these cognitive biases. We describe how caregivers can recognize these biases in the clinical setting and suggest interventions to help patients recognize and address affective forecasting errors.

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“…Mesmo no Brasil, onde o tratamento é universal, existem incertezas envolvendo a terapia, adesão, prognóstico e iatrogênesis. Em vez de ser uma doença consideravelmente previsível, estereotipada e com um curso fatal, a AIDS passou a ser uma doença prolongada com exacerbações e remissões, com uma carga de doença cumulativa crescente, com efeitos tóxicos significativos advindos da TARV, com crescentes comorbidades médicas e psiquiátricas 7 .…”

Section: Conclusãounclassified

“…Diante desse novo quadro de comorbidades é razoável esperar que um número maior de causas de morte seja observado por indivíduo, quando há utilização da TARV, tanto devido ao aumento de sobrevida com o tratamento, associado ao maior tempo de exposição a doenças, quanto pelo surgimento das novas comorbidades associadas à doença pelo HIV 7 . Daí a importân-cia de se utilizar causas múltiplas, pois num contexto de aumento da sobrevida dos portadores do HIV, ou dos indivíduos com AIDS, passa a ser importante descrever e analisar os determinantes patológicos da mortalidade em populações, como complemento ao uso tradicional da causa básica como modelo, que não é capaz de descrever o quadro global do processo mórbido 8,9 .…”

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Perfis de causas múltiplas de morte relacionadas ao HIV/AIDS nos municípios de São Paulo e Santos, Brasil, 2001

2007

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Após a introdução da terapia anti-retroviral de alta potência (TARV), o perfil da morbimortalidade relacionada ao HIV alterou-se, passando de óbitos causados por doenças oportunistas para quadros mórbido-crônicos de doenças "pré-AIDS", ou não definidoras de AIDS, causadas pelos efeitos adversos da terapia. Investigou-se a mortalidade relacionada ao HIV/AIDS através das causas múltiplas de morte, utilizando-se as declarações de óbito de residentes nos municípios de São Paulo e Santos, Brasil, que faleceram de causas relacionadas à doença pelo HIV em 2001. Utilizou-se o método Grade of Membership (GoM), que possibilitou criar perfis de causas de morte. Foram encontrados três perfis de mortalidade: o primeiro, relacionado às causas de morte identificadas no período pré-TARV, com predominância de doenças oportunistas; no segundo, houve uma mistura de características do período pré e pós-TARV; o terceiro perfil, residual, não contemplou a doença pelo HIV, mas incorporou grupos de causas de morte associadas aos períodos pré e pós-TARV. Espera-se que este estudo contribua para a elaboração de políticas direcionadas à adequação dos serviços de saúde ao novo cenário de morbimortalidade relacionada ao HIV.

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Overcoming the False Dichotomy of Curative vs Palliative Care for Late-Stage HIV/AIDS

Cited by 66 publications

References 58 publications

Literature on integrated HIV care: a review

Literature on integrated HIV care: a review

Affective Forecasting: An Unrecognized Challenge in Making Serious Health Decisions

Perfis de causas múltiplas de morte relacionadas ao HIV/AIDS nos municípios de São Paulo e Santos, Brasil, 2001

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