Clinician Mindfulness and Attention to Risky Behaviors in Patients with HIV/AIDS

Saha S, Flickinger T, Korthius PT, Moore R, Beach MC. Clinician Mindfulness and Attention to Risky Behaviors in Patients with HIV/AIDS. Paper presented at: American Academy on Communication in Healthcare Research and Teaching Forum; 2014 Oct 18; Orlando, FL.

Background: Clinician mindfulness is associated with clinicians' own well-being, better communication with patients, and higher patient satisfaction. Mindfulness may also improve clinical care by increasing clinicians' cognitive capacity and enabling them to more comprehensively attend to patients' needs and concerns, particularly difficult topics that require time and mental energy to address, such as counseling about risky behaviors. We assessed whether clinician mindfulness is associated with greater attention to risky behaviors during clinical encounters with patients with HIV/AIDS. Methods: We conducted a cross-sectional study of 45 clinicians and 437 of their HIV-infected patients in four geographically dispersed cities across the United States. Clinicians completed surveys that included the 14-item Mindful Attention Awareness Scale. Patients completed surveys including information on health behaviors (sexual activity, drug use, and antiretroviral medication non-adherence). We audio-recorded clinical encounters to assess whether these behavioral topics were addressed during the visit when relevant. We analyzed the association of clinician mindfulness scores with presence or absence of counseling for patients engaging in potentially risky behavior. Results: Mindfulness scores among clinicians ranged from 2.6 to 5.9 (possible range 1-6) with a mean of 4.3. The scale had good internal consistency (Cronbach's alpha 0.90). Overall, 157 of 437 patients reported being sexually active, 124 of 437 reported drug use, and 60 of 335 patients on antiretroviral medications reported missing doses. Clinicians rating themselves as more mindful counseled more often about safe sex (OR 3.15, 95% CI 1.04-9.54) and drug use (OR 1.37, 95% CI 1.02-1.82). Mindfulness was not associated with differences in discussing medication adherence. Discussion: Greater mindfulness among clinicians was associated with more comprehensive counseling about potentially risky health behaviors among patients with HIV/AIDS. Interventions to increase mindfulness may improve not only clinicians' well-being but also their cognitive capacity to address risky behaviors in high-risk patients.