SOCIAL BARRIERS TO ADVANCE CARE PLANNING IN THE UNITED STATES

Twenty-seven years after the passage of the Patient Self-Determination Act, a significant minority of older adults in the United States still lack complete, actionable advance care plans. Issues of access and information are important, but are not the full story. Barriers including cultural values and attitudes and social ties also prevent older adults from engaging in this important preventive health care behavior. This symposium delves into these barriers from the perspectives of human development, nursing, social work, and sociology. Three papers take up the theme of cultural values and attitudes. Noh’s focus groups indicated that African American older persons preferred greater use of life-sustaining treatments than white older persons did, not only because of lack of rapport with doctors but also because of belief and hope in recovery. Supiano and colleagues analyzed narratives of anticipated conditions at end-of-life to explore the role that values played in determining care preferences. Ahmed and colleagues found that just as with other preventive health behaviors, men who endorsed a hegemonic masculinity were less likely to engage in advance care planning. Two papers investigated personal relationships. Koss looked at a spouse’s role in promoting planning, finding that men’s experiences had a greater effect on their wives than vice versa. Moorman and Boerner concluded that variations in the size, composition, and quality of older adults’ social networks are a significant influence on who they prefer to involve in end-of-life decision-making. Discussant Waldrop will make connections across disciplines and draw out implications for policymakers and practitioners.