DISCUSSION OF PREFERENCES FOR LIFE-SUSTAINING CARE BY PERSONS WITH AIDS - PREDICTORS OF FAILURE IN PATIENT-PHYSICIAN COMMUNICATION

Objectives: To assess the determinants of communication about resuscit ation between persons with acquired immunodeficiency syndrome (AIDS) a nd their physician. Design and Setting: Structured patient interview a t a staff-model health maintenance organization (HMO), an internal med icine group practice at a private teaching hospital, and an AIDS clini c at a public hospital. Patients: 289 persons with AIDS. Main Results: Only 38% of patients had discussed their preferences for resuscitatio n with their physician. Using logistic regression, we found that patie nts were less likely to have discussed resuscitation with their physic ian if they were nonwhite (odds ratio [OR], 0.49; 95% confidence inter val [CI], 0.24 to 0.99), had never been hospitalized (OR, 0.52; 95% CI , 0.27 to 0.99), or were cared for in the HMO (OR, 0.44 relative to th e private teaching hospital; 95% CI, 0.23 to 0.82). Patients were more likely to have discussed their preferences if they were not currently taking zidovudine (OR, 1.76; 95% CI, 1.02 to 3.03) and if they had de cided to defer life-sustaining therapy (OR, 2.30; 95% CI, 1.35 to 3.91 ). Among nonwhites, those with a nonwhite physician were more likely t o have discussed resuscitation (OR, 4.38; 95% CI, 1.13 to 16.93). Of p atients who had not discussed their preferences for life-sustaining ca re, 72% wanted to do so. Patient desire for discussion of this issue d id not vary by race, severity of illness, hospitalization status, use of zidovudine, or site of care. Conclusions: A majority of persons wit h AIDS in this study had not discussed their preferences for life-sust aining care with their physician, despite the desire to do so. Interve ntions to improve patient-physician communication about resuscitation for nonwhites and other groups at risk of inadequate discussion might lead to clinical decisions that are more consistent with patient prefe rences.