According to lead researcher Joel Tsevat, M.D., M.P.H., a physician and researcher with the Veterans Healthcare System of Ohio and the University of Cincinnati Medical Center, the study is one of few to show that, surprisingly, many seriously ill patients are happier with life since their diagnosis. He cited anecdotal reports of this phenomenon from nurses, psychologists and other healthcare providers, but said there is scant evidence of it in the medical literature.
In the study, funded by the Department of Veterans Affairs and the National Center for Complementary and Alternative Medicine, patients compared their life before and after their diagnosis. About 32 percent said life was "better" since they learned they were HIV positive; 29 percent said life was "worse" 26 percent said life was "about the same" and the others said they "didn't know." The patients were recruited from two VA medical centers and two university medical centers.
The researchers found that patients who said life had improved reported fewer worries about finances or disclosure of their illness than the other patients. They expressed more optimism and greater life satisfaction, and were more likely to participate in non-organized religious activities, such as prayer, meditation or Bible study. Those who said life was better were almost equally represented among the three classes of HIV patients in the study: patients without symptoms, those with symptoms but without AIDS, and those with full-blown AIDS. About 61 percent of patients in the study had AIDS, as defined by the Centers for Disease Control and Prevention.
Tsevat said the findings jibed with those from a smaller study of HIV patients he conducted in the mid-1990s. In that study, he said, many HIV-positive patients reported "they had learned to appreciate life more than they used to. They no longer took things for granted. Things like a nice day, a change in the seasons, family —they just appreciated what they had a lot more."
Tsevat's team will follow patients in the study for an additional 15 months to learn more about the factors associated with increased post-diagnosis satisfaction. A long-range goal of the research is to design and test interventions to help patients better cope with their illness.
"If we say a third of patients think life is better, what can we do for the other two-thirds, who haven't gotten to that point? Interventions might include, for example, providing more financial support or counseling for HIV patients, or referring them to chaplains for spiritual or religious guidance," said Tsevat.
Tsevat's collaborators on the study were Dr. Susan N. Sherman, Veterans Healthcare System of Ohio and University of Cincinnati Medical Center; Dr. Judith Feinberg, UCMC; Drs. Joseph M. Mrus, Anthony C. Leonard and Karen L. Mandell, VHSO and UCMC; Dr. William C. Holmes, University of Pennsylvania; Drs. Amy C. Justice and Shawn L. Fultz, VA Pittsburgh Healthcare System; and Dr. Christina M. Puchalski, George Washington University Medical Center.
SPECIAL NOTE TO REPORTERS: If you are not attending the Society of General Internal Medicine (SGIM) conference, but would like to pursue a story, Joel Tsevat, M.D., M.P.H., is available for press interviews, April 30, 2003 thru May 3, 2003. Please contact the SGIM Communications Director, Lorraine Tracton, at 604-647-7401. Dr. Tsevat can also be reached at the Pan Pacific Hotel, 604-662-8111 or tsevatj@ucmail.uc.edu. After May 3, please call Suzanne Tate, Veterans Healthcare System of Ohio, at 513-475-6516 or suzanne.tate@med.va.gov. For additional assistance, please contact Jim Blue at 212-807-3429.