Term of Award

Spring 2020

Degree Name

Doctor of Public Health (Dr.P.H.)

Document Type and Release Option

Dissertation (restricted to Georgia Southern)

Copyright Statement / License for Reuse

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


College of Public Health

Committee Chair

Tilicia Mayo-Gamble

Committee Member 1

Gulzar Shah

Committee Member 2

Bettye Apenteng

Non-Voting Committee Member

Richard Sams


Background: Approximately 2.6 million people die each year in the United States. Out of the 2.6 million deaths, more than half are attributed to complications from chronic diseases. Thus, the need to increase the quality of life at the end of life is imperative. Advanced care planning (ACP) is an essential component to increasing the quality life at the end of life by delivering effective preventive care for patients. The purpose of this study was to identify factors associated with the decision to engage in advanced care planning. Method: This study employed a QUANT-Qual sequential design. In Phase I, descriptive analysis was performed to describe characteristics of the study population. Spearman correlation analysis and a binary logistic regression were conducted to determine the association between factors of the Information Motivation Behavioral model and three ACP variables. In the second phase of this study, in-depth interviews were conducted to explore the quantitative results. Deductive-Inductive content analysis was conducted to analyze the data for emerging themes. Results: Results of the binary logistic regression indicated that the model was a significant predictor of information and motivation factors (attitudes on medical decision-maker score, ACP knowledge), and patient’s income level. From content analysis, seven themes emerged in both participants with an ACP and participants without an ACP : (1) Patient’s Level of Understanding of ACP; (2) Knowledge Gaps Surrounding ACP; (3) Patient Preference for End-of-Life Care; (4) Facilitators for Engaging in ACP; (5) Barriers to Engaging in ACP; (6) The Role of Communication in ACP; (7) Inconsistent Perspectives on the Role of Religion in ACP. Three additional themes were identified in participants without an ACP: (1) Benefits to ACP; (2) Desired Information/Resources in ACP; (3) Timeline for Decision to Engage. Discussion: Results from this study suggest that in order to increase the uptake of ACP, interventions must include implementation measures to increase communication among patients, their families and their health care providers using information and motivation factors.

OCLC Number


Research Data and Supplementary Material