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

我们建议以最近死亡的人为样本，研究临终规划对他们的生活质量的影响。 死亡过程，以及幸存者的心理和经济福祉。我们使用的数据在 最近的死者在去世前获得的临终规划活动;因此，我们拥有独特的 有机会前瞻性地研究临终规划对他们随后的福祉的影响， 失去亲人的家庭成员我们还将调查死者的临终规划是否与 在生命结束时接受的护理质量，以及临终体验的质量， 评估是由两个丧亲家庭成员谁是知识渊博的回顾性 死者的临终经历我们的研究将基于威斯康星州纵向研究的数据 (WLS)，一项针对1957年从威斯康星州高中毕业的男女以及他们的兄弟姐妹的大型调查。 我们建议对自2003-05年以来死亡的WLS毕业生和兄弟姐妹进行持续跟踪 接下来我们将采访两位死者家属。我们将： (1)确定自最近一次访谈以来死亡的WLS参与者（使用社会保障 行政数据、国家死亡指数和死亡证明），并进行45分钟的电话采访 与两个重要的其他人（例如，死者的配偶、子女、兄弟姐妹、其他亲属），包括被指名的人 作为DPAHC（N=~ 1，070）。采访将在死亡后大约9个月进行; (2)检查死者的财务和健康的个别和综合组成部分在多大程度上- 相关的临终规划会影响死者临终体验的质量，包括疼痛和痛苦， 延长染色过程。 (3)检查死者的财务和健康的单独和组合组成部分- 相关的临终计划影响幸存亲属的心理（即，抑郁症状、焦虑、酗酒 使用，悲伤），和财务福祉（即，资产的变化、感知到的财务压力、临终关怀的费用）。 (4)评估临终规划与死亡质量之间的关系程度（目标2） 反映了两种可能的解释途径：死者接受护理的地点和质量（例如，疼痛 管理，坚持病人的意愿）;和家庭和专业的冲突，周围的临终关怀。 (5)评价临终规划与幸存者福祉之间的关系（目标3） 反映了三种可能的解释途径：围绕临终关怀的家庭和专业冲突; 死者所接受的护理的地点和质量;以及死者临终体验的质量。 (6)评估目标（4）和（5）中记录的关联反映持久性的程度 幸存亲属和最近死者的特征，例如历史上良好的家庭关系， 可以促进临终规划和最佳的临终/丧亲结局。

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.