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ECI 01-195 – HSR&D Study

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ECI 01-195
Health Values and Spirituality in Veterans with HIV/AIDS
Joel Tsevat MD MPH
Cincinnati VA Medical Center, Cincinnati, OH
Cincinnati, OH
Funding Period: May 2002 - June 2005

BACKGROUND/RATIONALE:
We have previously shown that: 1) time tradeoff utilities for current health are high, indicating that patients have a strong will to live; 2) half of patients felt that their life was better now than before they were HIV-infected; and 3) certain non-health-related factors such as spirituality and concern and love for one’s children correlated with health values and a sense that life has improved.

OBJECTIVE(S):
1) To assess health values of veterans and non-veterans with HIV/AIDS; 2) To characterize spirituality in patients with HIV/AIDS; 3) To derive a power function relating health ratings to utilities; and 4) To assess whether society assigns higher values to health states for veterans than for non-veterans.

METHODS:
We interviewed 100 representative veterans with HIV/AIDS from the Cincinnati and Pittsburgh VAMCs and, concurrently, 350 non-veterans with HIV/AIDS from Cincinnati and Washington, DC, twice over 12-18 months. The patient questionnaire included clinical and demographic data; health values measures; a question comparing life now with life before being infected with HIV; and measures of health status/health concerns, HIV symptoms, depressive symptoms, spirituality/religion, adherence, social support, self-esteem, and optimism. We also assessed how medical house officers rate and value the health state of a hypothetical patient with congestive heart failure, identified either as a 72-year-old veteran or merely as a 72-year-old male.

FINDINGS/RESULTS:
Five papers and 11 abstracts reporting results have been published or presented at national meetings. Findings include: 1) approximately 1/3rd of veterans (and non-veterans) with HIV/AIDS feel that their life is better now than it was before they knew they had HIV/AIDS; 2) most patients with HIV/AIDS belong to an organized religion but participate in non-organized religious activities more often than in organized ones, and optimistic patients, minorities, and patients who drink alcohol less tend to be more spiritual and religious; 3) despite having different demographic characteristics, worse health status, and more bothersome symptoms than non-veterans with HIV/AIDS, veterans with HIV/AIDS have similar medication adherence rates; 4) patients with HIV/AIDS report relatively high levels of social support, but certain factors are associated with poor social support, such as lower spiritual well-being, negative religious coping, HIV status disclosure worries, depression, poor self-esteem, being single, and being unemployed; 5) medical house officers assess the value of living with moderate functional impairment from congestive heart failure to be relatively high, with no difference between the values for veterans and non-veterans; 6) the majority of patients with HIV report significant depressive symptoms, and having significant depressive symptoms is associated with lower levels of social support, optimism, and life satisfaction, poorer health status and beliefs, and poorer spiritual well-being; and 7) in comparing patients with HIV, hepatitis C, or both, health values are driven more by symptoms, function, and spirituality than by infection type or number of infections.

IMPACT:
Findings from this study should be of great benefit not only to researchers, policy makers, and clinicians, but also to veterans (and non-veterans) with HIV/AIDS in their quest to make the best of a potentially devastating illness.

PUBLICATIONS:

Journal Articles

  1. Tsevat J, Leonard AC, Szaflarski M, Sherman SN, Cotton S, Mrus JM, Feinberg J. Change in quality of life after being diagnosed with HIV: a multicenter longitudinal study. AIDS Patient Care and Stds. 2009 Nov 1; 23(11):931-7.
  2. Cotton S, Puchalski CM, Sherman SN, Mrus JM, Peterman AH, Feinberg J, Pargament KI, Justice AC, Leonard AC, Tsevat J. Spirituality and religion in patients with HIV/AIDS. Journal of general internal medicine. 2006 Dec 1; 21 Suppl 5:S5-13.
  3. Cotton S, Tsevat J, Szaflarski M, Kudel I, Sherman SN, Feinberg J, Leonard AC, Holmes WC. Changes in religiousness and spirituality attributed to HIV/AIDS: are there sex and race differences? Journal of general internal medicine. 2006 Dec 1; 21 Suppl 5:S14-20.
  4. Kudel I, Farber SL, Mrus JM, Leonard AC, Sherman SN, Tsevat J. Patterns of responses on health-related quality of life questionnaires among patients with HIV/AIDS. Journal of general internal medicine. 2006 Dec 1; 21 Suppl 5:S48-55.
  5. Mrus JM, Leonard AC, Yi MS, Sherman SN, Fultz SL, Justice AC, Tsevat J. Health-related quality of life in veterans and nonveterans with HIV/AIDS. Journal of general internal medicine. 2006 Dec 1; 21 Suppl 5:S39-47.
  6. Sherman SN, Mrus JM, Yi MS, Feinberg J, Tsevat J. How do patients with HIV/AIDS understand and respond to health value questions? Journal of general internal medicine. 2006 Dec 1; 21 Suppl 5:S56-61.
  7. Szaflarski M, Neal Ritchey P, Leonard AC, Mrus JM, Peterman AH, Ellison CG, McCullough ME, Tsevat J. Modeling the Effects of Spirituality/Religion on Patients' Perceptions of Living with HIV/AIDS. Journal of general internal medicine. 2006 Dec 1; 21 Suppl 5:S28-38.
  8. Yi MS, Mrus JM, Wade TJ, Ho ML, Hornung RW, Cotton S, Peterman AH, Puchalski CM, Tsevat J. Religion, Spirituality, and Depressive Symptoms in Patients with HIV/AIDS. Journal of general internal medicine. 2006 Dec 1; 21 Suppl 5:S21-7.
Conference Presentations

  1. Tsevat J, Puchalski CM, Sherman SN, Holmes WC, Feinberg J, Leonard AC, Mrus JM, Mandell KL, Pargament KI, Justice AC, Fultz SL, Ellison CG, McCullough ME, Peterman AH. Spirituality and religion in patients with HIV/AIDS. Paper presented at: Society of General Internal Medicine Annual Meeting; 2003 May 1; Vancouver, Canada.
  2. Tsevat J, Sherman SN, Feinberg J, Mrus JM, Leonard AC, Mandell KL, Holmes WC, Justice AC, Fultz SL, Puchalski CM. Can life improve after developing HIV/AIDS. Paper presented at: Society of General Internal Medicine Annual Meeting; 2003 May 1; Vancouver, Canada.
  3. Mrus JM, Sherman SN, Puchalski CM, Leonard AC, Fultz SL, Justice AC, Mandell KL, Tsevat J. Health utilities of veterans and non-veterans with HIV/AIDS. Paper presented at: VA HSR&D National Meeting; 2003 Feb 21; Washington, DC.


DRA: none
DRE: Etiology, Technology Development and Assessment
Keywords: HIV/AIDS, Quality of life, Research measure
MeSH Terms: Health Services, HIV, Quality of Life