Although meeting patients' preferences is a central component of quality chronic and end-of-life care, patients' preferences are frequently not met. A necessary first step to meeting preferences is to improve advance care planning, the process by which patients express their preferences for future care in the case that they can no longer participate in decision-making. The results of study on which this competitive renewal is based suggest that the traditional conceptualization of advance care planning (ACP) as the completion of documents is inadequate. Rather, ACP is better conceptualized as a process of communication between patient and both caregiver and physician about patients' treatment goals. Further, ACP may be best conceptualized as a health behavior. The aim of this project is to apply models of health behavior change to advance care planning in order to determine the components, dimension, and scope of potential interventions to improve ACP. The project proposes the use of mixed qualitative and quantitative methods. In the qualitative portion, focus groups and individual interviews will be utilized to elicit the perceptions of older community-dwelling persons with advanced cancer, congestive heart failure, and chronic obstructive pulmonary disease and their caregivers regarding the constructs of the Health Beliefs and Transtheoretical Models as they relate to ACP. Standard qualitative analytical techniques will be used to ground an understanding of the concepts of susceptibility, barriers, benefits, self-efficacy, stages of change, and processes of change as they relate to ACP in the experiences of patients and caregivers of diverse ethnic and racial backgrounds. In the quantative portion of the study, scales will be developed to facilitate the measurement of these concepts. The development of quantitative measures is a necessary prerequisite for future work to examine relationships among the constructs and between the constructs and ACP, which will provide further insights into the design of effective interventions.
