THE IMPACT OF END-OF-LIFE PLANNING ON THE QUALITY OF DEATH & SURVIVOR WELL-BEING

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We propose to examine for a sample of recent decedents the impact of end-of-life planning on the quality of their dying process, and on the psychological and financial well-being of their survivors. We make use of data on the recent decedents' end-of-life planning activities obtained prior to their deaths; thus, we have the unique opportunity to examine prospectively the influence of end-of-life planning on the subsequent well-being of their bereaved family members. We also will investigate whether the decedent's end-of-life planning is associated with the quality of care received at the end of life, as well as the quality of the dying experience, where such assessments are offered retrospectively by two bereaved family members who are knowledgeable about the decedent's end-of-life experiences. Our research will be based on data from the Wisconsin Longitudinal Study (WLS), a large survey of men and women who graduated from Wisconsin high schools in 1957, and their siblings. We propose a continuous tracking of deaths to WLS graduates and siblings who have died since the 2003-05 wave of data collection, and we will then interview two bereaved family members. We will: (1) Identify participants in the WLS who have died since the most recent interview (using Social Security Administration data, National Death Index, and death certificates), and conduct a 45-minute telephone interview with two significant others (e.g., spouse, child, sibling, other relative) of the decedent, including the person named as DPAHC (N=~1,070). Interviews will take place roughly nine months following the death; (2) Examine the extent to which individual and combined components of the decedent's financial and health- related end-of-life planning affect the quality of the decedent's dying experience, including pain and suffering, and prolongation of the dying process. (3) Examinethe extent to which both individual and combined components of the decedent's financial and health- related end-of-life planning affect the surviving kin's psychological (i.e., depressive symptoms, anxiety, alcohol use, grief), and financial well-being (i.e., changes in assets, perceivedfinancial strain, costs of end-of-life care). (4) Evaluate the extent to which the relationship between end-of-life planning and the quality of dying (Aim 2) reflects two possible explanatory pathways: the locus and quality of care received by decedent (e.g., pain management, adherence to patient's wishes); and family and professional conflict surrounding end-of-life care. (5) Evaluate the extent to which the relationship between end-of-life planning and survivors' well-being (Aim 3) reflects three possible explanatory pathways: family and professional conflict surrounding end-of-life care; the locus and quality of care received by decedent; and quality of decedent's dying experience. (6) Assessjhe extent to which the associations documented in aims (4) and (5) reflect enduring characteristics of the surviving kin and recent decedent, such as historically good family relationships, which may facilitate both end-of-life planning and optimal end-of-life/bereavement outcomes.