Health-Care Decision Making at the Latter End of the Lifespan
Open Access
- Author:
- Ohs, Jennifer E.
- Graduate Program:
- Communication Arts and Sciences
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- October 02, 2008
- Committee Members:
- Jon F Nussbaum, Dissertation Advisor/Co-Advisor
Jon F Nussbaum, Committee Chair/Co-Chair
Dennis Stephen Gouran, Committee Member
Roxanne Louise Parrott, Committee Member
Rachel Annette Smith, Committee Member
Roger Kent Finke, Committee Member - Keywords:
- uncertainty management
decision making
health-care decisions
older adults - Abstract:
- Decisions involving health care in later life entail consideration of a complex and diverse set of issues, making the process of decision-making a challenging and uncertain one for an older adult. The social relationships that are pertinent to the decision situation and significant in the lives of older adults can serve to support or further complicate their decision-making. As health care decisions have far reaching effects for the well-being and survival of older adults (Park, 1999) and the decision-making process is fundamentally a communicative activity (Street, 2007), understanding the communicative influences on the health care decision-making processes for older adults is essential. Guided by the Theory of Motivated Information Management (TMIM) (Afifi & Weiner, 2004) and an ecological perspective (Street, 2007), this study examined the personal decision-making networks of older adults faced with a major health care decision. Interview and survey methods were utilized to gather information about older adults’ information-seeking behavior during the decision-making process as well as regarding the influence of numerous communication contexts on the process and outcome of the decision-making. Personal decision-making networks (n=62) were developed from the data gathered that illustrated communication properties of interest, such as frequency of decision contact, relational quality, and influence on the decision process and outcome. The ties between and influence of the members (targets) in each participant’s decision-making network (n=279) were also analyzed according to participants’ perception of frequency of decision contact, relational quality, and direction of influence between the members of the network. Personal social network analysis of the decision-making networks revealed that networks fall along a continuum of influence ranging from dominance of organizational influence on the process and outcome of decision-making to dominance of interpersonal influence. The type of health care decision mediates the influence of organizational and interpersonal contexts in networks. Analyses of the interactions reported by participants among network members demonstrated that older adults who reported reciprocal interactions with their adult children over the course of their decision-making experienced a decrease in their anxiety with the process of decision-making, where older adults who reported that their adult children attempted to influence their decision-making reported an increase in anxiety. Further, a decision-maker’s propensity for involvement in their health care decision predicted use of media sources for information during the decision-making process. Additionally, older-adult decision-makers’ communication efficacy predicted their information-seeking behavior during the decision-making process, demonstrating partial support for the TMIM. The implications of the findings for medical professionals involved in the health care decisions of older adults and families who seek to support older adults facing a major health care decision are discussed, as well as considerations for advancing information-seeking theory.