Graduation Semester and Year

Fall 2025

Language

English

Document Type

Dissertation

Degree Name

Doctor of Philosophy in Nursing

Department

Nursing

First Advisor

Dr. Mari Tietze

Second Advisor

Dr. Daisha Cipher

Third Advisor

Dr. Zhaoli Liu

Abstract

Advance Care Planning (ACP) is a critical component of patient-centered care, yet its utilization remains disproportionately low among Non-White populations in the United States, particularly among individuals with chronic illnesses such as heart disease and cancer. This article explores racial disparities in ACP engagement using secondary analysis of the 2018 and 2020 waves data from the Health and Retirement Study (HRS), guided by Bandura’s self-efficacy theory (SET). The study examines how race, disease type, comorbidity, and survey year predict ACP service utilization, defined as completing five key ACP components: a legal will, a medical care discussion, surrogate assignment (DPOA), a written living will, and limited care preferences. The analytic sample (n = 2,011) was drawn from a nationally representative cohort of adults aged 50 and older. The study's findings recommend targeted interventions, including culturally sensitive communication training for healthcare providers, standardization of ACP policies, and the integration of digital tools to enhance ACP accessibility. By identifying modifiable barriers and predictors, this research advances health equity and improves end-of-life care outcomes for underserved populations.

Keywords

Advance Care Planning (ACP), Advance Directives (ADs), racial disparities, heart disease, cancer, Health and Retirement Study (HRS), comorbidity, end-of-life care, health equity, Bandura’s theory of self-efficacy (SET).

Disciplines

Cardiovascular Diseases | Clinical and Medical Social Work | Family Practice Nursing | Geriatric Nursing | Nursing | Oncology | Other Nursing | Palliative Nursing | Public Health and Community Nursing

License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

Comments

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