Advance care planning and documentation of goals of care designation among adults (≥18 years) living with human immunodeficiency virus (HIV): A cross-sectional study
Avantika Vashisht, Raman Brar, Jacqueline McMillanAbstract
Objectives
Antiretroviral therapy has transitioned human immunodeficiency virus (HIV) into a manageable chronic condition. As such, advance care planning is critical to providing patient-centered care for aging persons with HIV. The objectives of the study were to determine the proportion of adults living with HIV in Southern Alberta with a documented goals of care designation and explore factors influencing this documentation.
This was a cross-sectional study conducted at Southern Alberta HIV Clinic in Alberta, Canada. Participants were adults ≥18 years receiving HIV care during the study period (January 1, 2022, and December 31, 2023). Age, sex, family physician status, emergency department (ED) visits, hospitalizations, and goals of care documentation were extracted from the electronic health record. Descriptive statistics and chi-square tests were used to analyze associations.
Results
Ten percent (255/2567) of adults with HIV had a goal of care documentation in the electronic health record. Documentation did not differ by age, sex, or family physician status. Among patients with an ED visit in the prior year, 21% (225/1065) had a goal of care documentation compared to 2% of those without ( p < 0.0001). Among those hospitalized in the prior year, 56% (203/364) had a goal of care documentation, compared to 2% of those without ( p < 0.0001).
Significance of results
A minority of adults living with HIV had a goal of care documentation.. These findings highlight missed opportunities and areas for improvement for advanced care discussions. There is an urgent need to enhance advanced care planning in this population.