OBJECTIVE: To describe the characteristics, interventions, and outcomes for patients referred to a new HIV palliative care consultation service.
SETTING: University-affiliated teaching hospital (1300 beds) in the Bronx, NY, one of five HRSA-funded Special Projects of National Significance for HIV and Palliative Care. Team includes a physician, nurse practitioner, social worker, psychiatrist, chaplain, and bioethicist.
MEASUREMENTS: Demographics, Karnofsky score, Memorial Symptom Assessment Scale (MSAS), presenting problems, interventions, and outcomes.
RESULTS: Forty-one patients were enrolled from June through October, 2000. Median age was 43 yrs (range 22-68); 56% patients were Hispanic, 39% African-American, 45% female; 39% were drug injectors, 37% heterosexual contacts. Median CD4+ count was 32 (range 1-426), 90% had prior AIDS-defining illnesses. Median Karnofsky score was 40. Most patients were referred for pain, depression, and family stress. Most patients reported current pain, (61%, MSAS); of these, 64% reported constant pain; 55% had no pain treatment. Patients also presented with depression, (34%), anxiety (27%) and health care proxy issues (24%). The most frequent recommendations were for analgesia, psychiatric consultation, and advance care planning. Presenting problems were fully or partially resolved in 75% and 86% of cases, respectively. Eleven patients (27%) died, from AIDS related complications (n=8), liver failure (n=2), and ALS (n=1).
CONCLUSIONS: Preliminary experience at a large urban teaching hospital suggests an unmet need for palliative care for patients with HIV/AIDS, even in the era of highly active antiretroviral therapy. Referral reasons were both medical and psychosocial; mortality reflected both AIDS-related and non-AIDS-related causes.
Learning Objectives: 1. To understand clinical and program development issues in provision of palliative care to patients with HIV/AIDS in the current therapeutic era. 2. To summarize preliminary experience of a palliative care consultation service in an urban teaching hospital with patient referrals and outcomes.
Keywords: End-of-Life Care, Urban Health Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Montefiore Medical Center/Albert Einstein College of Medicine
Bronx, New York 10467
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.