Abstract

Older adults often face complex serious illness decisions and involve their adult children as shared or surrogate decision makers. However, previous research asking family members to predict older adults’ treatment preferences in serious illness situations typically shows poor concordance with older adults’ actual preferences. In the current mixed methods analysis, we surveyed older adults (n = 38) on their health state valuations in five serious illness scenarios. Two of their adult children (n = 76) predicted their parent’s preferences. Families also participated in a semi-structured conversation to discuss their preferences and predictions. Quantitative analyses showed that parents’ average valuations were significantly more pessimistic for living with Alzheimer disease than any other health state. Children’s predictions of parent valuations were moderately accurate for Alzheimer disease but poor for all four health states describing physical illnesses, and on average, children slightly overestimated parents’ valuations. However, there was wide variability both within and across families in terms of valuations and prediction accuracy. Through qualitative thematic analysis of conversations, we identified four themes related to individual reasoning underlying valuations and family negotiation about each other’s opinions: (1) family members’ perceptions of dependence and shame in health states, (2) children’s prediction strategies of substituted judgment versus projection, (3) children’s persuasion of parents toward consensus, and (4) family members’ assertions protecting the parent’s autonomy. Findings from this study have broad implications for communication and surrogate decision making in late-life families.

Committee Chair

Brian Carpenter

Committee Members

Patrick Hill, Renee Thompson

Degree

Master of Arts (AM/MA)

Author's Department

Psychology

Author's School

Graduate School of Arts and Sciences

Document Type

Thesis

Date of Award

Winter 12-2023

Language

English (en)

Author's ORCID

https://orcid.org/0000-0002-0649-6284

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