Factors influencing end-of-life decisions regarding the living will and durable power of attorney: An application of Roy's Adaptation Model

Abstract

Modern technology offers extraordinary life-saving opportunities that were not imaginable in old times. However, it also takes us to a new frontier where the challenge of life-saving becomes death-prolonging. More than a decade after the Patient Self-Determination Act which guarantees the individual's legal right to decide the end-of-life care, the utilization of this right has seen no significant increase.

The purpose of this quantitative study was to identify the variables that influence the decision-making responses related to Advance Directives (ADs).

A path model applying Roy's Adaptation Model was developed for the study. Publicly accessible data collected for the Longitudinal Study of Aging from 1984 to 2000 constituted the study sample. The sample consisted of 938 participants. Items were extracted and scales were constructed from survey questions to correspond to study variables.

The final path model showed that age and gender significantly contributed to the number of hospital and nursing home admissions. The number of hospital and nursing home admissions was significantly associated with physical impairment. Physical impairment had the greatest effect on the decision-making responses. Thus, more physical impairment predicts more AD completion. The degree of physical impairment also had indirect effects on AD completion through its influence on self-perception about health and role function mode. Although the indirect effect was very small, more physical impairment was related to poorer perceptions about one's health which in turn predicted that individuals were less likely to work or do volunteer work. Those who were less likely to continue working or do volunteer work were also less likely to complete ADs. In addition, those who perceived their health as poorer were more likely to get help from their children or family and were less likely to sign an AD.

The study indicated that physical impairment, self-perception about health, role function in work or volunteer work, and family structure explained 5% of the variance on decision-making responses for AD completion. The factors identified by this study could provide useful strategies for nurses in order to improve end-of-life care. These findings also provide an initial direction for further theory refinement.