Date of Graduation

1997

Document Type

Dissertation/Thesis

Abstract

This study was designed to accomplish seven goals. First, the preferences of nursing home residents for life-sustaining treatments and less acute medical problems were examined. Second, analyses were conducted to determine whether specific variables differentiated between participants' patterns of treatment preferences. Third, participants' medically-related values were examined. Fourth, the factors believed to play a role in the formation of participants' treatment preferences and values were examined. Fifth and sixth, the temporal stability of participants' treatment preferences and values was examined. Seventh and eighth, factors associated with the instability of participants' treatment preferences and values were studied. To accomplish these goals, 45 nursing home residents responded to six hypothetical vignettes involving life-sustaining treatments (5) and a non life-sustaining treatment (1). Participants also responded to questions assessing their medically related values, mood, level of cognitive functioning, and self-perception of health. Each participant responded to the questionnaires twice, approximately one month apart. T-tests were used to determine whether participants who selected life-sustaining treatments on all vignettes differed significantly from participants who chose three or fewer life-sustaining treatments. Phi correlation and Pearson product-moment correlation coefficients were calculated to determine the stability of participants' treatment preferences and values, respectively, over time. The relations between selected dependent measures, treatment preference instability, and value instability were examined with Pearson correlation analyses. Stepwise multiple regression analyses were used to determine the extent to which participants' ratings of values statements could be predicted from the dependent variables. Results revealed that participants tended to prefer life-sustaining and non life-sustaining treatments. Individuals who chose life-sustaining treatments were older, male, and valued preserving life at any cost. Preserving autonomy, quality of life, and minimizing pain were the most important medically-related values. Both gender and subjective level of energy were helpful in predicting responses to value statements. Statistical stability ranged across treatment preferences and values, but neither were judged stable in a practical sense. These results suggest that maintaining an "up to date" documentation of specific treatment preferences and values in response to wide variety of situations is a crucial component of ensuring nursing home residents' self-determination in medical care.

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