"There's Nothing Wrong with You that an Expensive Operation Can't Prolong": An Exploration of Health Literacy, End-of-Life Care Preferences, and Death Exposure

• Main Author: Albright, Amy E
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01-01-2020
• Subjects: Adults; Attitudes; Collaboration; Context; Literacy; Medical personnel; Older people; Patients; Physicians; Psychology; Public health; United States > US
• ISBN: 9798582556800

Health literacy influences the ways in which individuals access and utilize health information to promote well-being, and the following interrelated studies examined functional health literacy in community-dwelling adults in the context of advance care planning. When assessing health literacy, it is important to first establish basic functional levels of this construct, as this may provide crucial information regarding the ways in which patients interact with the healthcare system. Study One established the importance of assessing functional health literacy among older adults in a primary care context, as significant discrepancies were noted between patients’ subjective reports of health literacy and their objective ability to understand and manipulate health information. This is an important trend to monitor, as it is becoming increasingly necessary for U.S. adults to make decisions regarding end-of-life care in collaboration with their medical providers. Functional health literacy is an important factor to consider in this context, as it may influence the care that patients desire at the end of life. Based on the findings in Study One regarding the importance of functional health literacy, Study Two examined ways in which functional health literacy and death exposure influenced preferred end-of-life interventions. It was found that these variables did not influence aggressiveness of end-of-life care choices; however, general knowledge of palliative care was low, and further research is needed to clarify how understanding of palliative care influences advance care planning. Finally, Study Three continued the exploration of end-of-life decision-making by examining attitudes towards physician-assisted death (PAD), an end-of-life intervention that is becoming increasingly common within the United States. Factors such as religiosity and attitudes regarding PAD were found to influence individual support for the legalization of PAD. Furthermore, there was a significant positive association between health literacy and PAD, indicating that those with higher health literacy were more supportive of PAD, even within a sample of adults with low palliative care knowledge. Implications regarding these findings include the necessity of screening for functional health literacy, as well as assisting patients to engage in both informal and formal advance care planning as early as possible.