End-of-Life Planning Prior to Death Among People Living With HIV.

The study was done at a single HIV clinic, so the rates and associations may not apply to other settings. It relied on electronic medical record documentation, and some patients may have completed an advance directive or medical power of attorney without it being scanned or recorded. The analysis is retrospective and observational, so it can show links with hospice enrolment, age, CD4 count, and cause of death, but it cannot show that these factors caused better planning. Most patients were male, so the study had limited ability to detect sex differences. Informal medical power of attorney status was based on verbal verification, and the authors noted possible misclassification. The paper did not test an intervention, so it does not show that asking patients or involving nurses will improve completion rates.

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Do not read the strong link between hospice enrolment and planning as proof that hospice enrolment creates advance directives or medical powers of attorney. The study was a retrospective chart review and did not test an intervention.