Semester

Spring

Date of Graduation

2002

Document Type

Dissertation

Degree Type

PhD

College

Eberly College of Arts and Sciences

Department

Psychology

Committee Chair

Barry Edelstein.

Abstract

Previous research suggests that older adults prefer less information and involvement in medical decision-making scenarios than younger adults. No previous research has empirically explored the factors that might influence the information and involvement preferences of older adults in medical decision-making scenarios. The present study involved an investigation of the influence of four factors on information and involvement needs: the complexity of the medical information, cognitive abilities, attitudes toward medical authority and health locus of control beliefs. Complexity was defined by contrasting reading levels (i.e., medical scenarios written at the 4th- vs. 11th-grade reading level). Cognitive abilities were measured using the Logical Memory subscale from the Wechsler Memory Scale and the following subscales from Wechsler Adult Intelligence Scale - Third Edition: Matrix Reasoning, Digit-Symbol Coding, Vocabulary and Digits Forward and Backward. Attitudes toward medical authority were assessed using an adaptation of a questionnaire developed by Haug and Lavin (1981). Health locus of control beliefs were assessed using the Multidimensional Health Locus of Control scale (Wallston, Wallston, & DeVellis, 1978) and the God Locus of Health Control scale (Wallston et al., 1999). Two, written medical scenarios were used; one involved breast cancer while the other involved cervical cancer. Sixty women, aged 60 years and over, participated in the study. Using Likert-type scales, participants were asked to rate how involved they would prefer to be in treatment and how much information they would prefer regarding nine topic areas (i.e., diagnosis, side effects of treatment, what the treatments do, likelihood of a cure, potential consequences of metastases, what the treatments do inside the body, effectiveness of treatment for other patients, examples of cases of treatment effectiveness and ineffectiveness). Principal component analyses were conducted to yield predictors that were subsequently used in multiple regression analyses. Results revealed that none of the four factors were significantly related to preferences for information in the two scenarios. Similarly, performance on the cognitive variables and manipulations of the complexity of the scenario were not related to preferences for involvement in the two scenarios. However, beliefs that one's health is controlled by external agents (e.g., a Higher Power, chance or powerful others) were related to preferences for less involvement within the cervical cancer scenario. In addition, preferences for less involvement were significantly correlated with decreased tendencies to believe in a patient's rights (i.e., rights to challenge medical authority, obtain information and make medical decisions) in medical settings. Implications of these results and suggestions for future research are provided.

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