BARRIERS TO COMMUNICATION ABOUT END-OF-LIFE CARE IN AIDS PATIENTS

OBJECTIVE: Patients and physicians do not adequately discuss patients' preferences for medical care at the end of life. Our objective was to perform a qualitative study using focus groups to identify barriers a nd facilitators to communication about end-of-life medical care for pa tients with AIDS and their physicians. PARTICIPANTS: Patients with AID S and physicians with moderate or extensive HIV experience were recrui ted from clinics and community-based settings using network sampling. A total of 47 patients participated in six focus groups and 19 physici ans participated in three groups. MEASUREMENTS AND MAIN RESULTS: Patie nts or physicians identified 29 barriers and facilitators to communica tion about end-of-life care. Many patients and physicians expressed di scomfort talking about death and dying, and some felt that discussing end-of-life care could cause harm or even hasten death. Several patien ts expressed the view that a Living will obviated the need for discuss ion with their physician. Previous experience of discrimination from t he health care system was a strong barrier to end-of-life communicatio n for some patients with AIDS. Some patients hesitate to bring up end- of-life issues because they want to protect their physicians from unco mfortable discussions. Many patients identified the quality of communi cation as an important facilitator to these difficult discussions. CON CLUSIONS:Improving the quality of patient-physician communication abou t end-of-life care will require that physicians identify and overcome the barriers to this communication. To improve the quality of medical care at the end of life, we must address the quality of communication about end-of-life care.