An Examination of end-of-life decisions in younger- and middle-aged adults
Abstract
Previous research has found that choices about end-of-life decisions are typically
not made prior to terminal diagnosis (Bomba & Sabatino, 2009). Although research has
examined end-of-life decision making after receiving a terminal diagnosis, few studies
have investigated proactive end-of-life decision making. Similarly, few studies have
focused on those who may be making such proactive decisions (i.e., young and middleaged
adults) with the majority of research focused on older adults. This study examined
proactive end-of-life decision making by comparing younger adults and their selected
middle-aged adults in choosing whether to select life-sustaining treatment after imagining
fictional diagnoses of terminal illness with one month to live (with or without loss of
cognitive functioning). In addition, the influence of religiosity, self-control, and other
factors that have been demonstrated to contribute to reactive end-of-life decision making
were assessed (Cicerelli, MacLean & Cox, 2000; Mishra & Lalumiere, 2010; Winter,
Dennis & Parker, 2009).
One-hundred-sixty-one younger and middle-aged adults (82% women) were
surveyed in person, through mail or via email. Participants imagined being diagnosed and
then decided whether they would select life-sustaining treatment, rated the influence of
factors contributing to their decision and completed a religiosity and self-control survey.
Findings from this study indicated that, regardless of age, less than 50% of participants
had communicated about end-of-life decisions with friends and loved ones and even
fewer had communicated with medical care providers. Consistent with research,
surrogates were more likely to select treatment for others who are faced with a terminal
illness than when faced with their own terminal illness. In addition, having hope that the
disease will improve was a significant predictor of selecting life-sustaining treatment
while making peace and being ready to move on was predictive of not selecting lifesustaining
treatment. Unlike the older adult reactive research (Carr & Moorman, 2009),
this study found no relationship between proactive treatment decisions and religiosity,
religious affiliation, or self-control. This suggests that treatment decisions may differ
when they are not fictitious or may differ by age group. Future research should continue
to compare treatment decisions by age group. Further, research should continue to
investigate what factors influence treatment decisions among all age groups. If
confirmed, these findings will allow researchers, medical staff and clinicians to better
understand influences on proactive end-of-life treatment decisions and may assist in
guiding the treatment process.
Subject
Psychological aspects of death
Terminal care
Death
Permanent Link
http://digital.library.wisc.edu/1793/62196Description
A Thesis Submitted In Partial Fulfillment of the Requirements For the Degree of Master of Science-Psychology Experimental Psychology