Date of Conferral

2020

Degree

Doctor of Psychology (Psy.D.)

School

Psychology

Advisor

Peggy Gallaher

Abstract

Despite the benefits of advance care planning (ACP), only one third of older adults in the United States have completed it. To address this gap, health care organizations are implementing ACP programs to engage older adults in the process. These programs can be delivered in various ways, including 1:1 conversations, classes, and web-based tools. The purpose of this quantitative study was to investigate which ACP option was associated with highest participation and advance directive (AD) completion rates in older adults. Social cognitive theory provided the framework to understand the impact the ACP environment and personal characteristics’ have on the odds of participating and completing an AD. A nonequivalent group design was used to compare participation and AD completion rates between groups. Results of logistic regression indicated that a sample of 24,909 older adults who were offered one of the three ACP options exhibited higher AD completion rates than the 133,766 individuals who were not offered it. Those who were offered and participated in the 1:1 conversation exhibited the highest AD completion rate. Age was the only personal characteristic associated with higher participation and AD completion rates. Findings may be used for positive social change to inform health care organizations’ strategies to address low AD rates among older adults.

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