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，研究临终计划对其质量的影响。 死亡过程，以及其幸存者的心理和经济福祉。我们使用的数据是 最近死者在去世前获得的临终计划活动；因此，我们有独特的 有机会前瞻性地审查临终规划对其后续福祉的影响 失去亲人的家庭成员。我们还将调查死者的临终计划是否与 生命末期接受的护理质量，以及临终体验的质量，如 评估由两名丧亲家庭成员提供，他们了解 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性和女性及其兄弟姐妹的大型调查。 我们建议持续追踪2003-05年度以来死亡的WLS毕业生和兄弟姐妹的死亡情况。 数据收集的浪潮，然后我们将采访两名失去亲人的家庭成员。我们会： (1)确定WLS中自最近一次面谈以来已死亡的参与者(使用社会保障 管理数据、国家死亡指数和死亡证书)，并进行45分钟的电话采访 与死者的两个重要的其他人(如配偶、子女、兄弟姐妹、其他亲属)，包括被指名的人 DPAHC(N=~1,070)。采访将在死者去世后大约九个月进行； (2)审查被继承人的财务和健康的个别组成部分和综合组成部分- 相关的临终计划影响死者临终体验的质量，包括痛苦和痛苦，以及 延长染色过程。 (3)检验死者的经济和健康的个别组成部分和综合组成部分在何种程度上- 相关的临终计划会影响幸存亲属的心理(即抑郁症状、焦虑、酗酒 使用、悲伤)和财务健康(即资产变化、感受到的财务压力、临终关怀的费用)。 (4)评估临终计划与染色质量之间的关系程度(目标2) 反映了两种可能的解释途径：死者接受护理的轨迹和质量(例如，疼痛 管理、坚持病人意愿)；以及围绕临终关怀的家庭和职业冲突。 (5)评估临终规划与幸存者福祉之间的关系程度(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职业冲突； 死者接受护理的地点和质量；以及死者临终经历的质量。 (6)AIMS(4)和(5)中记录的协会在多大程度上反映了经久不衰 尚存亲属和最近去世的人的特征，如历史上良好的家庭关系， 可促进临终规划和最佳临终/丧亲结果。

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.