I Know I Should, but I Haven't: South Australian Baby Boomers Forever Contemplating Advance Care Directives

Author: Sandra L Bradley

Bradley, Sandra L, 2012 I Know I Should, but I Haven't: South Australian Baby Boomers Forever Contemplating Advance Care Directives, Flinders University, School of Nursing & Midwifery

This electronic version is made publicly available by Flinders University in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. This thesis may incorporate third party material which has been used by the author pursuant to Fair Dealing exceptions. If you are the owner of any included third party copyright material and/or you believe that any material has been made available without permission of the copyright owner please contact copyright@flinders.edu.au with the details.


As we grow older, many of us will be asked to assist in making decisions about healthcare and welfare management for those we love and support. This will be especially true for the generation born between 1945 and 1965 known as the Baby Boomers. Involvement in such decision-making may lead Boomers to consider their own future healthcare and welfare management. It remains unclear however whether or to what extent Boomers have considered such decision-making for themselves. Knowing in advance the healthcare and welfare decisions Boomers might make is important for healthcare policy planning, especially in states such as South Australia with high populations of people aged 65 and older. It will be a challenge for the Government of South Australia to preserve personal autonomy in decision-making in an environment of dwindling healthcare resources as the first of whole generations (i.e. the Boomers) retire and enter older age at the same time, something not previously envisioned in earlier generations. The literature speculates about the types of healthcare Boomers themselves will require in the future but there is little evidence to guide policy makers, academics and others to the extent and type of healthcare this generation will actually demand. One way to provide evidence of this future demand is to study the use of instruments called advance directives (ADs), or in the proposed future vernacular, advance care directives (ACDs), by Boomers for recording their decisions on healthcare and welfare decision-making. Advance care directives are instruments that define aspects of healthcare and welfare through guardianship and substitute decision-making instructions. These instruments inform others of the individual's values, including what constitutes a quality of life for them. These instruments are particularly relevant to the Boomer generation as they were the generation that politicised the need for them as part of the consumer choice movement informing the early years of their maturation. To evaluate Boomer ACD decision-making, this research used a qualitative methodological approach that enabled subjective understanding of the experience of ACD decision-making for a sample of this generation in South Australia. The qualitative methodological approach of classical grounded theory (CGT) was chosen for its ability to explain from the 'ground up' basic social and psychological processes influencing human behaviour and practice. Ethical approval was then gained for interviewing a purposive sampling of South Australian Boomer participants on their experience of ACD use. To elicit factors influencing ACD decision-making, semi-structured interviews using audio-tape recording were transcribed verbatim. Data were then coded and analysed using the constant comparative analysis (CCA) method of CGT to uncover the Basic Social Psychological Process (BSPP) underpinning the ACD decision-making of the participants. Results of this research identified a core category of contemplation to describe the BSPP. Three levels of non-linear contemplating behaviour were found: contemplation of knowledge of ACDs; contemplation of relationships with others for substitute decision-making; and contemplation of actions/inactions for ACD completion. Participants in this research identified that they often moved between these levels of contemplation depending on the context in which ACDs were considered. Findings from this study reflect what previous research on the frail elderly, chronically and terminally ill have suggested influenced ACD decision-making, such as age, mortality and choice of SDM. What makes this research significant is that the participants in this research were young, in good health and were not a targeted audience for creation of ACDs by advance care planning programs. Their perceptions of ACD use suggest that other factors may be influential in generating contemplation of ACDs before people reached ill health or frail age. These factors include experiential knowledge of the healthcare system, favourable SDMs and professional guidance to complete ACDs. If these and other factors named by participants in this study were made available, then ACDs could be completed in a timely manner. If, however, these factors were not available, then some of the participants in this study chose to continue contemplating ACDs.

Keywords: advance directives,Baby Boomers,decision-making,classical grounded theory
Subject: Nursing thesis

Thesis type: Masters
Completed: 2012
School: School of Nursing & Midwifery
Supervisor: Dr Anita DeBellis and Dr Evdokia Kalaitzidis