Advance Care Planning among Midlife and Older Adult Sexual Minority Men - Project Summary.
In times of serious illness or at the end of life, many Americans receive unwanted care, including life-
prolonging and painful interventions, and die in institutional settings. Advance care planning (ACP) permits
individuals to communicate their preferences should they become unable to make decisions regarding their
own medical care due to physical, cognitive, and/or communicative impairments. ACP improves the
concordance between persons’ wishes and the care they receive, and increasing the utilization of ACP can
yield benefits to patients, kin and families, and the health care system. Very little is known regarding ACP
disparities and predictors among midlife and older adult gay, bisexual, and other men who have sex with men
(GBMSM). Existing ACP research has numerous gaps, and GBMSM have distinct life experiences that limit
generalizing from existing data regarding ACP behaviors in the general population. It is not known whether
there are disparities in ACP across sociodemographic groups such as race, ethnicity, and socioeconomic
status among GBMSM. There is also a need to identify psychosocial factors that may influence ACP behaviors
among GBMSM. This research will examine formal and informal dimensions of two ACP behaviors (health care
proxy, advance directives) using secondary data analyses from the Multicenter AIDS Cohort Study, a
longitudinal study of GBMSM with extensive data on sociodemographics, health and health care, and
psychosocial factors. The specific aims are to 1) Describe the types and extent of advance care planning
(ACP) among midlife and older adult GBMSM, and assess potential disparities across sociodemographic
groups; 2) Assess differences in the prevalence of ACP across longitudinal health indicators, and longitudinal
health care access and utilization; and 3) Test associations between psychosocial factors and ACP, and
whether these associations differ across HIV serostatus groups. This research is critical to understanding ACP
among older GBMSM, developing culturally-appropriate models of ACP, and addressing within-group
disparities. Improving rates of ACP among GBMSM supports high quality care that is concordant with patients’
wishes during severe illness or at the end of life. These findings will also move the broader field of ACP
research forward by virtue of examining factors that are understudied in ACP research more generally (e.g.,
psychosocial factors).
