Negotiating advance directives for persons with AIDS

A focus group was conducted to determine the views of persons with AIDS about how to best conduct the process of establishing advance directives. (Advance directives are instructions regarding future medical care to be implemented should a patient be unable to communicate his/her treatment preferences.) Several hypotheses emerged from this focus group that were then formally tested with a questionnaire. The results of the questionnaire identified (a) predictors of attitudes toward advance directives and (b) predictors of the act of having established a directive. Based upon the findings from the focus group and the questionnaire, recommendations for social workers raising the issue of advance directives can be made. First, time for the client to adjust to seropositive notification should be allowed prior to raising the advance directive issue. Second, the advance directive issue should be raised in the context of empowerment rather than being embedded in other paper work. Third, people who are most likely to be disturbed by the process of establishing advance directives are those who have low health locus of control, low trait optimism, low reliance on active involvement as a coping mechanism, and low reliance on distraction as a coping mechanism. More time should be allotted for people with those characteristics.