| Summary |
Increased susceptibility to illness and alterations in cognitive function make elderly persons especially vulnerable to loss of self-determination when advance planning for the end of life is not in place. The elderly approve of end-of-life decision making, prefer to address these issues while well, are highly certain about treatment choices, and realize psychological benefits from making these choices known. However, they are neither discussing their preferences with families and health care providers, nor are they completing advance directives. Phenomenological methodology was used to describe the experience of end-of-life decision making among well elders, and discover its meaning. In-depth, unstructured interviews about their experiences were conducted with 5 persons over age 65, who were well by self-report, living independently, and who had completed formal advance directives. Colaizzi's existential-phenomenological methodology was used for data analysis. End-of-life decision making, as described, is motivated by prior experiences that demonstrate its value, and by awareness of personal mortality, vulnerability to loss of self-determination, and a responsibility to make end-of-life choices known. It is facilitated by a variety of support resources and mediated by common values. The experience promotes well-being that includes peace of mind, satisfaction, and the security of knowing that a self-determined plan is in place to guide end-of-life care. These descriptive results can be used to guide more meaningful communication about and facilitation of planning for the end of life among elderly persons, their families, nurses, and other health care providers. |
