An Exploratory Analysis of Advance Care Planning Typologies in a Sample of Midlife and Older Adult Sexual Minority Men

Advance care planning (ACP) allows individuals to specify preferences for care and surrogate decision makers that may be needed during a serious illness or at the end of life. Cisgender sexual minority men (SMM) are an overlooked population in most ACP research. We used latent class analysis and data from a sample of midlife and older adult SMM in the Multicenter AIDS Cohort Study. Pre-contemplators (28%) were unlikely to have engaged in any ACP. Contemplators (17%) had thought about ACP but had not taken action. Formal Preparers (22%) had completed documents and asked someone to be their surrogate decision-maker but were unlikely to have thought about specific values or the flexibility afforded to their surrogate. Full Preparers (33%) had completed documents and also considered specific values and the flexibility afforded to their surrogate. Pre-Contemplators and/or Contemplators generally reported less socially supportive relationships, greater loneliness, less optimism, and less resilience than Formal Preparers and Full Preparers. Full Preparers had the highest level of AIDS-related bereavement. To maximize self-determination and preference concordant care, future ACP research and direct practice with SMM should be cognizant of underlying constellations of planning behaviors and psychosocial factors that may act as barriers or facilitators to planning.