Advance care planning and HIV symptoms in adolescence

Maureen E. Lyon, Patricia A. Garvie, Lawrence J. D'Angelo, Ronald H. Dallas, Linda Briggs, Patricia M. Flynn, Ana Garcia, Yao I. Cheng, Jichuan Wang

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

OBJECTIVES: To determine the effect of family-centered pediatric advance care planning (FACE pACP) on HIV-specific symptoms. METHODS: In this single-blinded, randomized controlled trial conducted at 6 US hospitalbased HIV clinics, 105 adolescent-family dyads, randomly assigned from July 2011 to June 2014, received 3 weekly sessions in either the FACE pACP arm ([1] pediatric advance care planning survey, [2] Respecting Choices interview, and [3] 5 Wishes directive) or the control arm ([1] developmental history, [2] safety tips, and [3] nutrition and exercise tips). The General Health Assessment for Children measured patient-reported HIV-specific symptoms. Latent class analyses clustered individual patients based on symptom patterns. Path analysis examined the mediating role of dyadic treatment congruence with respect to the intervention effect on symptom patterns. RESULTS: Patients were a mean age of 17.8 years old, 54% male, and 93% African American. Latent class analysis identified 2 latent HIV-symptom classes at 12 months: Higher symptoms and suffering (27%) and lower symptoms and suffering (73%). FACE pACP had a positive effect on dyadic treatment congruence (β = .65; 95% CI: 0.04 to 1.28), and higher treatment congruence had a negative effect on symptoms and suffering (β = -1.14; 95% CI: -2.55 to -0.24). Therefore, FACE pACP decreased the likelihood of symptoms and suffering through better dyadic treatment congruence (β = -.69; 95% CI: -2.14 to -0.006). Higher religiousness (β = 2.19; 95% CI: 0.22 to 4.70) predicted symptoms and suffering. CONCLUSIONS: FACE pACP increased and maintained agreement about goals of care longitudinally, which lowered adolescents' physical symptoms and suffering, suggesting that early pACP is worthwhile.

Original languageEnglish (US)
Article numbere20173869
JournalPediatrics
Volume142
Issue number5
DOIs
StatePublished - Nov 1 2018

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Advance Care Planning
HIV
Pediatrics
Patient Care Planning
HIV-2
Therapeutics
African Americans
Randomized Controlled Trials
Interviews
Exercise
Safety
Pain

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Lyon, M. E., Garvie, P. A., D'Angelo, L. J., Dallas, R. H., Briggs, L., Flynn, P. M., ... Wang, J. (2018). Advance care planning and HIV symptoms in adolescence. Pediatrics, 142(5), [e20173869]. https://doi.org/10.1542/peds.2017-3869

Advance care planning and HIV symptoms in adolescence. / Lyon, Maureen E.; Garvie, Patricia A.; D'Angelo, Lawrence J.; Dallas, Ronald H.; Briggs, Linda; Flynn, Patricia M.; Garcia, Ana; Cheng, Yao I.; Wang, Jichuan.

In: Pediatrics, Vol. 142, No. 5, e20173869, 01.11.2018.

Research output: Contribution to journalArticle

Lyon, ME, Garvie, PA, D'Angelo, LJ, Dallas, RH, Briggs, L, Flynn, PM, Garcia, A, Cheng, YI & Wang, J 2018, 'Advance care planning and HIV symptoms in adolescence', Pediatrics, vol. 142, no. 5, e20173869. https://doi.org/10.1542/peds.2017-3869
Lyon ME, Garvie PA, D'Angelo LJ, Dallas RH, Briggs L, Flynn PM et al. Advance care planning and HIV symptoms in adolescence. Pediatrics. 2018 Nov 1;142(5). e20173869. https://doi.org/10.1542/peds.2017-3869
Lyon, Maureen E. ; Garvie, Patricia A. ; D'Angelo, Lawrence J. ; Dallas, Ronald H. ; Briggs, Linda ; Flynn, Patricia M. ; Garcia, Ana ; Cheng, Yao I. ; Wang, Jichuan. / Advance care planning and HIV symptoms in adolescence. In: Pediatrics. 2018 ; Vol. 142, No. 5.
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abstract = "OBJECTIVES: To determine the effect of family-centered pediatric advance care planning (FACE pACP) on HIV-specific symptoms. METHODS: In this single-blinded, randomized controlled trial conducted at 6 US hospitalbased HIV clinics, 105 adolescent-family dyads, randomly assigned from July 2011 to June 2014, received 3 weekly sessions in either the FACE pACP arm ([1] pediatric advance care planning survey, [2] Respecting Choices interview, and [3] 5 Wishes directive) or the control arm ([1] developmental history, [2] safety tips, and [3] nutrition and exercise tips). The General Health Assessment for Children measured patient-reported HIV-specific symptoms. Latent class analyses clustered individual patients based on symptom patterns. Path analysis examined the mediating role of dyadic treatment congruence with respect to the intervention effect on symptom patterns. RESULTS: Patients were a mean age of 17.8 years old, 54{\%} male, and 93{\%} African American. Latent class analysis identified 2 latent HIV-symptom classes at 12 months: Higher symptoms and suffering (27{\%}) and lower symptoms and suffering (73{\%}). FACE pACP had a positive effect on dyadic treatment congruence (β = .65; 95{\%} CI: 0.04 to 1.28), and higher treatment congruence had a negative effect on symptoms and suffering (β = -1.14; 95{\%} CI: -2.55 to -0.24). Therefore, FACE pACP decreased the likelihood of symptoms and suffering through better dyadic treatment congruence (β = -.69; 95{\%} CI: -2.14 to -0.006). Higher religiousness (β = 2.19; 95{\%} CI: 0.22 to 4.70) predicted symptoms and suffering. CONCLUSIONS: FACE pACP increased and maintained agreement about goals of care longitudinally, which lowered adolescents' physical symptoms and suffering, suggesting that early pACP is worthwhile.",
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