Outcomes/Effectiveness Research

Patients with HIV who share treatment decisions with their doctor have better outcomes

Patients with HIV benefit from discussions with their doctor regarding the varied types of highly active antiretroviral therapy (HAART) used to treat the disease. Patients who prefer to share treatment decisions with their HIV provider have better outcomes than those who want their HIV provider to make all or most of the decisions and those who want to make decisions alone, according to a new study.

A team of Johns Hopkins University researchers, led by Mary C. Beach, M.D., M.P.H., interviewed a group of predominantly young black male patients at an urban HIV clinic. Interviews revealed that 23 percent preferred a more passive role, with their doctor making all or most of the decisions, 63 percent preferred to share decisions with their doctor, and 13 percent preferred to make all final decisions alone.

Compared to the other two groups, passive patients were 43 percent less likely to adhere to HAART. Those who made decisions alone were 48 percent less likely to receive HAART or to have undetectable HIV RNA in their blood compared to the other two groups. However, after adjusting for patient characteristics and how patients judged the quality of communication with their doctor, the only result that remained significant was 42 percent less likelihood of adherence to HAART among the passive patients.

Adherence to HAART (no missed medication doses in the past 3 days) diminished the risk of developing HIV resistance to HAART and disease progression (indicated by levels of HIV RNA detectable in the blood). More than 80 percent of patients reported good communication with their primary HIV providers, but the passive and independent patients reported worse communication than those who shared decisions. Practicing clinicians should encourage shared decisionmaking by not only activating patients who are disengaged, but also building trust and rapport with patients who are highly independent, suggest the researchers.

Their study was supported in part by the Agency for Healthcare Research and Quality (HS13903).

See "Is patients' preferred involvement in health decisions related to outcomes for patients with HIV?" by Dr. Beach, Patrick S. Duggan, A.B., and Richard D. Moore, M.D., M.H.S., in the August 2007 Journal of General Internal Medicine 22, pp. 1119-1124.

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