Psychological Process of Family Members Participating in Terminal Patients’ Advance Care Planning in Home-based Care Model
Date Issued
2015
Date
2015
Author(s)
Ho, Hsueh-Lin
Abstract
Purpose: Past studies of advance care planning (ACP) mostly focused on the inclination and completion rate of advance directives and failed to make a rationale of study connected to health behavior-related theories. In Taiwan, while terminal patients’ advance directives were largely subscribed to family members, studies investigating family members’ experiences were relatively sparse. This study adopted the transtheoretical model (TTM) and social cognitive theory as frameworks and investigated characteristics of the psychological process (including stages of change and behavior expectancy) of terminal patients’ family members participating in patients’ ACP in a home-based caring setting. Method: This study used case-study methods. Ten family members of terminal patients were recruited. The data collected mainly included (1) a video of the course of communicating ACP between family members and medical staff and (2) one-on-one, semi-structured interviews with family members. The above data were analyzed with interaction process analysis and thematic analysis, respectively. Result: Family members’ behavior in discussions unfolded in four aspects, including “reflection and expression of personal viewpoint,” “communication with patient,” “communication with relatives,” and “communication with medical staff.” Concrete behaviors in the above four aspects were classified to depict each stage of change in participating in discussions of ACP, and related experiences that might reflect discussion behavior were also presented. Discussion & Conclusions: (1) The “stage of change” of TTM helped not only to depict behavior in discussing ACP in concrete terms, but also to reveal the complexity of discussion behavior; (2) “passive behavior” in discussion can be characterized by its evaluation result of low importance in outcome expectancy; and (3) “disease-versus-illness” explanatory models of sickness, the “physician-patient relationship,” and the “indigenous relationship-oriented cultural context” are important issues to be considered in future study of ACP.
Subjects
advance care planning
transtheoretical model
social cognitive theory
expectancy
community medicine
Type
thesis
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