Date of Award


Degree Type


Degree Name

Master of Science in Psychology


Clinical Psychology



First Advisor

Mark Robbins


Advance care planning (ACP) is a framework used to describe the process of end-oflife care planning. ACP includes four behaviors: completing a living will that documents end-of-life wishes, appointing a health care proxy (HCP), discussing the use of interventions with loved ones, and discussing quality versus quantity of life with loved ones. Studies have found that the number of individuals engaging in ACP is low. Further, even those who have completed a living will and HCP often have insufficient communication with loved ones regarding their end-of-life wishes, often leading to discordant end-of-life care. The present study used constructs from the Transtheoretical Model (TTM) to examine predictors associated with surrogates’ (N= 216) readiness (i.e., Stage of Change) to help their loved one complete ACP behaviors. Exploratory analyses including Analyses of Variance (ANOVAs) and correlations examined surrogate age, race, gender, experience with medical decision making relationship to the older patient, frequency of contact, perceived positive consequences of ACP behaviors (Pros), perceived negative consequence of ACP behaviors (Cons), and ACP attitudes values and cultural beliefs (AVCB) as potential predictors of surrogate readiness to assist their loved one in the four ACP behaviors. A series of multiple regressions showed that across the four ACP behaviors, only Cons was a significant predictor of Stage of Change, suggesting that as surrogates perceived more negative consequences of ACP, they were less ready to support the older patient in the process. This result is not consistent with other TTM research, in which Pros and Self Efficacy are generally stronger predictors of Stage of Change. This study also examines the level of agreement between older patients and their surrogates on readiness to engage in the four ACP behaviors. Difference scores between the surrogate Stages of Change and that of their older patient counterpart reflected discrepancies in readiness for ACP behaviors. ANOVAs and correlations were used to examine relationships between the level of agreement and the surrogate variables. Stage of Change distributions revealed surrogates were more ready to participate in ACP behaviors than the older patients, indicating that surrogates may play an important role in older patients’ readiness to complete ACP behaviors. Increased surrogate age was associated with less agreement on readiness to engage in creating a living will. Female gender and higher surrogate ratings on Pros was associated with more agreement in discussing interventions. Higher surrogate ratings of Cons was significantly associated with less agreement to discuss interventions, and more agreement to discuss quality versus quantity of life. Higher ratings on AVCB was significantly associated with less agreement in readiness to discuss interventions. Future longitudinal research may provide more information regarding these relationships.



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