Barcelona 2013
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| Abstract #602 - Well Being and Life Expectancy | ||||
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Session: 25.4: Well Being and Life Expectancy (Parallel) on Tuesday @ 11.00-13.00 in Raval Chaired by Xiaming Li, Carlos Mur Authors: Presenting Author: Ms Keira Lowther - Cicely Saunders Institute, Kings College London, United Kingdom |
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| Additional Authors: | ||||
| Aim: To evaluate the effectiveness of a nurse led palliative care intervention on psychosocial outcomes, using quantitative and qualitative methods over a four month period using a RCT design with qualitative interviews. | ||||
| Method / Issue: 120 HIV positive patients, established on ART for more than 1 month, reporting moderate to severe pain or symptoms were randomised to receive the intervention in addition to standard HIV care or standard HIV clinic care. Data was collected monthly over a period of 4 months (5 data-points), using multidimensional care measures of quality of life (MOS-HIV), pain, symptoms, worry, interpersonal and existential well-being (APCA African POS), psychiatric morbidity (GHQ 12), and details of service receipt (adapted CSRI). Qualitative interviews were conducted with 20 intervention patients and 10 control patients to explore the experience of receiving the intervention, participating in the trial and patient perceived impact. | ||||
| Results / Comments: Monthly quantitative analysis, controlling for baseline difference and baseline score, identified improved psychological well-being at month 1 and month 3(MOS-HIV MHSS), psychiatric morbidity at month 1 and month 2 (GHQ-12) and social well-being at months 1, 2, 3 and 4 (APCA African POS factor for interpersonal well-being) in the intervention arm. Using area under the curve analysis, improved psychological well-being was positively associated with receiving the intervention (p=<0.001 adjusted for baseline score) and negatively associated with wealth (p=0.04). Psychiatric morbidity was reduced in patients receiving the intervention (p=0.01) and increased in patients reporting higher wealth (p=0.05). Improved social well-being was also associated with receipt of the intervention using area under the curve analysis (p=0.01 adjusted for baseline score) and also with male gender (p=0.02). Qualitative analysis revealed benefit in both study arms from participation in the trial. Active ingredients were identified as time and attention. The mechanism of action suggested was the effect of time and attention on the expression and internalisation of HIV related stigma and in the creation and consolidation of social roles, leading to a more robust sense of purpose and thus psychosocial well-being. | ||||
| Discussion: These findings have implications for the care and treatment of people with HIV in resource poor settings of high stigma. The data suggests that simple psychosocial care components such as active listening and asking pertinent questions can have far reaching beneficial consequences, even when administered by a competently trained staff member with ongoing support. | ||||
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