Doctor–patient concordance during HIV treatment switching decision‐making

Objectives

The aim of the study was to explore levels of doctor–patient concordance during the making of decisions regarding HIV treatment switching and stopping in relation to patient health‐related outcomes.

Methods

Adult patients attending five HIV clinics in the United Kingdom were requested to complete the study questionnaire, which included a Concordance Scale, and measures of symptoms [Memorial Symptom Assessment Short Form (MSAS) index], quality of life (EuroQol), satisfaction, adherence and sexual risk behaviour. Clinical health measures (HIV viral load and CD4 cell count) were also obtained. A total of 779 patients completed the questionnaire, giving a response rate of 86%; of these 779 patients, 430 had switched or stopped their HIV treatment and were thus eligible for inclusion. Of these patients, 217 (50.5%) fully completed the Concordance Scale.

Results

Concordance levels were high (88% scored between 30 and 40 on the scale; score range 10–40). Higher concordance was related to several patient outcomes, including: better quality of life (P=0.003), less severe and burdensome symptom experience (lower MSAS‐physical score, P=0.001; lower MSAS‐psychological score, P=0.008; lower MSAS‐global distress index score, P=0.011; fewer symptoms reported, P=0.007), higher CD4 cell count (at baseline, P=0.019, and 6–12 months later, P=0.043) and greater adherence (P=0.029).

Conclusions

High levels of doctor–patient concordance in HIV treatment decision‐making are associated with greater adherence and better physical and psychological functioning. More research is needed to establish a causal relationship between concordance and these outcomes.