Decisions near the end of life must be made at a time of great emotional upheaval and rely on knowledge that few people possess outside of healthcare. Complicating this is that choices appear to change as older adults become more ill and approach death. Thus, healthcare providers must help older patients navigate this complexity to make decisions that are consistent with patients' priorities and wishes. Research examining end-of-life decisions has been descriptive in nature, looked at decisions from among younger adults, or examined decision making among those with cancer diagnoses. In addition, the research often focused on prospective decisions among healthy elders. Much less is known about decision-making processes used by older adults with a limited prognosis.
The aim of this dissertation was to examine decision-making processes among older adults with a limited prognosis who were in the midst of making significant healthcare decisions. The goal was to explore the phenomenon from within the context of the end of life to bring forth the missing voice of these elders.
Twenty community-based adults (13 men, 7 women, ages 67-97) with a prognosis of less than 12 months were recruited through the San Francisco Veterans' Administration Medical Center and the University of California, San Francisco, Division of Geriatrics. One-on-one interviews were conducted in participants' homes using a semi-structured interview guide. Interviews were recorded and transcribed verbatim. Grounded theory was used to analyze the interviews to allow themes and concepts to emerge organically from the data.
Two main themes emerged: maintaining a sense of control and decision making in the context of ambiguity. Participants rarely discussed actual decisions and preferred to delegate end-of-life decisions. By using different approaches to express their priorities and goals, they maintained the sense of control without being in control. The actual context of decisions could not be understood a priori, which resulted in uncertainty and ambivalence that influenced how decisions were made.
By understanding how older adults approach late-life decisions, healthcare providers can better support their patients as they make different choices and help guide patients to choices that are consistent with their stated preferences and priorities.
|Advisor:||Wallhagen, Margaret I.|
|Commitee:||Dawson-Rose, Carol S., Mayo, Ann M., Smith, Alexander K.|
|School:||University of California, San Francisco|
|School Location:||United States -- California|
|Source:||DAI-B 76/06(E), Dissertation Abstracts International|
|Subjects:||Gerontology, Aging, Nursing|
|Keywords:||Decision making, End of life care, Grounded theory, Perceived control, Prospect theory, Qualitative methods|
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