Department of Conflict Resolution Studies Theses and Dissertations

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Date of Award

2023

Document Type

Dissertation

Degree Name

Doctor of Philosophy in Conflict Analysis and Resolution

Department

Halmos College of Arts and Sciences - Department of Conflict Resolution Studies

First Advisor

Mary Schwoebel

Second Advisor

Neil Katz

Third Advisor

Elena P. Bastidas

Fourth Advisor

Ray E. Moseley

Keywords

advance care planning engagement, advance directives, conflict education, decisional conflict

Abstract

End-of-Life (EOL) refers to medical support given to those facing death and advance directives (AD) is a document that helps to distinguish the nature of that support. The literature suggests conflict is a barrier in the advance care planning (ACP) process and if it remains unresolved in the absence of an AD, there is prolongation of unwanted treatment, increased costs, and lower quality of care. The purpose of this research was to uncover decisional conflict and determine the usefulness of ACP engagement factors in faith communities through a unique intervention – CADE (Conflict and Advance Directives Education). Three theories – general systems theory, value theory, and Lederach’s model of conflict transformation were relevant in explaining the context of conflict around EOL and behavioral change. A posttest quantitative approach was used to check for decisional conflict and the level of two engagement factors, Readiness and Self-Efficacy. Upon statistical analysis, decisional conflict was detected with a higher score in the control group. For the ACP factors, participants were confident (had self-efficacy) in their decisions around EOL but lacked readiness to demonstrate flexibility and ask questions of their providers. Unmarried participants were most vulnerable and less ready to engage in the process. Among the participants who were ready to engage, they were certain about choosing their decision maker and asking provider questions. The high frequency of decisional conflict and the lack of readiness for ACP engagement during CADE solidified its potential as an educational resource to capture and minimize disparity in advance directives.

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