THE INFLUENCE OF A VALUES DISCUSSION ON CONGRUENCE BETWEEN ELDERLY WOMEN AND THEIR FAMILIES ON CRITICAL HEALTH CARE DECISIONS.
Contributors: University of Northern Colorado.
Published: 1994
Number of pages: 167
Subjects: Gerontology.; Health Sciences, Nursing.
Description: The purpose of this study was to investigate if prior discussion of personal values by competent older women with their significant family members assisted these family proxies to make critical health care decisions in congruence with the desires of the older women. The study also examined factors that influenced older women's preferences for care in critical health care situations.

The sample consisted of 60 women, over age 69, who were randomly assigned to an experimental or control group. The treatment for the experimental group consisted of a discussion of value indicators in the presence of their proxies. The proxies were instructed to make decisions in 10 situations across three mental states for the older women using the substituted judgment standard. The scenarios were an adaptation of the Preferences for Life-Sustaining Treatment Questionnaire.

The experimental group did not have statistically higher agreement than subjects in the control group in 28 of the 30 situations, but they had greater percentage agreement in 11 of the situations. Limitations of the kappa statistic in health care agreement studies were addressed. A significant relationship was found between variables of education, health, previous discussion of values in this study, and spirituality and 7 of the 30 treatment decisions. The predictive value of the variables was low to moderate (5-31%). The mean treatment decision scores were significantly different across mental states, indicating as mental acuity decreased, the women were more likely to refuse the recommended treatment. A logical-empirical process for making health care decisions did not emerge. For each woman, one to three value indicators stood out as the overriding influence in their decision making process, thus supporting the normative-affective decision making theory of Etzioni. The most frequently utilized themes were quality of life, previous health care experiences, outcomes, burden, and age. Over 50% of the women preferred that proxies use the substituted judgment standard in the future to make health care decisions for them. The principle of justice received mixed reactions. Recommendations for future research and implications for professional practice were made.
Notes: Source: Dissertation Abstracts International, Volume: 56-01, Section: A, page: 0314.

Thesis (PH.D.)--UNIVERSITY OF NORTHERN COLORADO, 1994.

School code: 0161.