An Examination of end-of-life decisions in younger- and middle-aged adults

Psychological aspects of death;Terminal care;Death

Beck, Eric W.Winterrowd, Erin ;

University of Wisconsin

关键词: Psychological aspects of death;    Terminal care;    Death;   

Others  :  https://minds.wisconsin.edu/bitstream/handle/1793/62196/Beck%2c%20Eric.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: University of Wisconsin

【 摘 要 】

Previous research has found that choices about end-of-life decisions are typicallynot made prior to terminal diagnosis (Bomba & Sabatino, 2009). Although research hasexamined end-of-life decision making after receiving a terminal diagnosis, few studieshave investigated proactive end-of-life decision making. Similarly, few studies havefocused on those who may be making such proactive decisions (i.e., young and middleagedadults) with the majority of research focused on older adults. This study examinedproactive end-of-life decision making by comparing younger adults and their selectedmiddle-aged adults in choosing whether to select life-sustaining treatment after imaginingfictional diagnoses of terminal illness with one month to live (with or without loss ofcognitive functioning). In addition, the influence of religiosity, self-control, and otherfactors that have been demonstrated to contribute to reactive end-of-life decision makingwere assessed (Cicerelli, MacLean & Cox, 2000; Mishra & Lalumiere, 2010; Winter,Dennis & Parker, 2009).One-hundred-sixty-one younger and middle-aged adults (82% women) weresurveyed in person, through mail or via email. Participants imagined being diagnosed andthen decided whether they would select life-sustaining treatment, rated the influence offactors 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 participantshad communicated about end-of-life decisions with friends and loved ones and evenfewer had communicated with medical care providers. Consistent with research,surrogates were more likely to select treatment for others who are faced with a terminalillness than when faced with their own terminal illness. In addition, having hope that thedisease will improve was a significant predictor of selecting life-sustaining treatmentwhile making peace and being ready to move on was predictive of not selecting lifesustainingtreatment. 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 differwhen they are not fictitious or may differ by age group. Future research should continueto compare treatment decisions by age group. Further, research should continue toinvestigate what factors influence treatment decisions among all age groups. Ifconfirmed, these findings will allow researchers, medical staff and clinicians to betterunderstand influences on proactive end-of-life treatment decisions and may assist inguiding the treatment process.