Advance Directives and Perspectives of Older People among Dunedin's Faith Communities

Abstract

Advance directives (ADs) are written or oral instructions concerning future health care interventions such as life sustaining treatments. The aim of the research was to explore perspectives of older people from faith communities regarding ADs. The research questions included: 1) how older people described their experience with the end of life care of their loved ones, and how their faith tradition affected their views on end of life care; 2) what they considered to be benefits and disadvantages to advance care planning; and 3) their reasons for completing or not completing advance directives.

This project used a qualitative approach with a combination of focus groups and interviews. Twenty four older adults were recruited from diverse faith communities in Dunedin. Data analysis techniques included thematic, content and narrative analysis. Several strategies were used to enhance methodological rigour, such as, prolonged engagement, member checks, triangulation, peer feedback, audit trail, thick description, and reflexivity. Question One generated spontaneous findings namely, respondents experienced discomfort in talking about death and dying, and stories about rest homes were a gateway to such conversations. The two top fears were dying in pain, and dying in an undignified manner through permanent loss of cognitive abilities. The respondents’ viewed God as the giver of life, they believed in an afterlife and emphasized the importance of religious rituals. On Question Two, the perceived benefits of ADs were improving communication, not being a burden to others, planning ahead, and ascertaining treatment options. Among the disadvantages were the AD limitations, communication difficulties, and problems with storage. On Question Three, the reasons for AD completion were death of a spouse, concern for family/survivors, autonomy - sense of control and empowerment, and having an independent personality. They also cited some reasons for not completing an AD such as fear of the unknown, avoidance, family expectations, faith in providers, and lack of information.

Practice implications for this study highlighted the need to improve communication about end of life care through storytelling, training of workers, and community outreach.