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AIDS. 1998 Jan 1;12(1):103-7.

End-of-life decisions in HIV-positive patients: the role of spiritual beliefs.

Author information

1
Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-8033, USA.

Abstract

OBJECTIVE:

To describe the role of spiritual beliefs in HIV-positive patients' end-of-life decisions.

DESIGN:

Inperson, cross-sectional survey.

SETTING:

An HIV/AIDS floor of an urban, university teaching hospital.

PATIENTS:

Ninety hospitalized HIV-positive patients.

MAIN OUTCOME MEASURES:

Prior discussions about advance directives, possession of a living will (written advance directive), fear of death, professions of hope and purpose in life, religious beliefs and practices, guilt about HIV infection, and perception of HIV as punishment.

RESULTS:

Of 104 eligible patients, 90 agreed to be interviewed. Twenty-four per cent of patients had discussed their resuscitation status with a physician and 17% possessed a living will; 44% of patients felt guilty about their HIV infection, 32% expressed fear of death, and 26% felt their disease was some form of punishment. Prior discussions about resuscitation status were less likely in those who perceived HIV as punishment (P=0.009) and more likely in those who believed in God's forgiveness (P=0.043). A living will was more common in those who prayed daily (P=0.025) and in those whose belief in God helped them when thinking about death (P=0.065). Fear of death was more likely in those who perceived HIV as punishment (P=0.01) or felt guilty about having HIV (P=0.039), and less likely in those who read the Bible frequently (P=0.01) or attended church regularly (P=0.015). Outcome measures did not vary significantly according sex, race, HIV risk factors, or education level.

CONCLUSIONS:

In this HIV-positive population, spiritual beliefs and religious practices appeared to play a role in end-of-life decisions. Discussions about end-of-life decisions may be facilitated by a patient's belief in a forgiving God and impeded by a patient's interpretation of HIV infection as punishment. Health-care providers need to recognize patients' spiritual beliefs and incorporate them into discussions about terminal care.

PMID:
9456260
[Indexed for MEDLINE]
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