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The Gerontologist 45:626-633 (2005)
© 2005 The Gerontological Society of America

Factors Affecting Long-Term-Care Residents' Decision-Making Processes as They Formulate Advance Directives

Heather C. Lambert, PhD1, Mary Ann McColl, PhD1, Julie Gilbert, PhD2, Jiahui Wong, MD, PhD2, Gale Murray, MA2 and Samuel E. D. Shortt, MD, PhD1

Correspondence: Address correspondence to Heather C. Lambert, PhD, Centre for Health Services and Policy Research, Queen's University, Abramsky Hall, 3rd floor, Kingston, Ontario K7L 3N6. E-mail: hcl{at}

Purpose: The purpose of this study was to describe factors contributing to the decision-making processes of elderly persons as they formulate advance directives in long-term care. Design and Methods: This study was qualitative, based on grounded theory. Recruitment was purposive and continued until saturation was reached. Nine residents of a long-term-care facility were interviewed by use of a semistructured format. Open and axial coding of interview transcripts were carried out and the factors contributing to the decision process were defined. Results: Elders based their decisions primarily on information gathered from personal experiences with death and illness. They obtained very little information from professionals or the media. Major factors considered by elders as they weighed information included spiritual, emotional, and social considerations. Implications: The factors considered during the decision-making process were oriented more toward the individual's experiences and less on contributions from objective sources than anticipated. Decision making for advance directives is a highly personalized process. The approach of health professionals when assisting with end-of-life decision making should be planned with these contributing factors in mind, so that the services offered to the individuals in this population best meet their needs.

Key Words: End of life • Advance care planning • Theoretical model • Grounded theory

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Copyright © 2005 by The Gerontological Society of America.