As a result of the 1990 Patient Self Determination Act (PSDA), it became mandatory for federally funded health care institutions to provide all patients an opportunity to complete advance care directives. These directives involve completing living wills or designating a durable power of attorney for health care (DPAHC). Health care professionals also encourage patients to discuss their end-of-life treatment preferences with loves ones to better ensure compliance. Approximately two-thirds of Americans have completed advance directives, and we know little about what deters the remaining population from engaging in end-of-life care planning.
To address the need for greater understanding about why some individuals do not participate in end-of-life care planning, most scholars have focused their attention on the association between certain structural factors (e.g., socioeconomic status, marital status) and end-of-life care planning. To broaden the scope, however, two researchers from Seoul National University in Korea and Kent State University in Ohio recently examined the impact that personality traits can have on the relationship between care receipt and end-of-life care planning. Namely, four personality traits—agreeableness, conscientiousness, neuroticism, and openness—were considered in this study. Agreeableness reflects the tendency to be tolerant and accepting rather than cynical and hostile. Agreeable people are eager to please others. Conscientiousness reflects elements of personality, such as self-discipline, responsibility, industriousness, and deliberation. Highly conscientious individuals are more likely to think about how their behaviors impact others. Individuals who score high on neuroticism tend to perceive others as untrustworthy and unsupportive. Finally, individuals scoring high on openness are highly tolerant of uncertainty. This trait is also positively associated with advanced problem-solving skills.
Dr. Jung-Hwa Ha and Dr. Manacy Pai examined data from the 2003-2004 waves of the Wisconsin Longitudinal Study, a survey of Wisconsin high school graduates from 1957 and 2004. Comparing care recipients to their peers who are not receiving care, Ha and Pai examined the impact of care receipt on the likelihood of completing informal (e.g., discussions) and formal (living will, DPAHC) end-of-life care plans. Compared to their peers not receiving care, care recipients were found to be more likely to engage in informal discussions about end-of-life care planning. While conscientiousness, agreeableness, and openness were found to have a positive direct effect on some aspects of end-of-life care planning, the moderating effect of personality traits was minimal. Contrary to expectations, openness was the only trait that showed significant influence in the relationship between care receipt and informal planning (e.g., having informal discussions with loved ones about one’s wishes regarding end-of-life treatment preferences).
Dr. Ha and Dr. Pai summarized their findings by stating that the surprising results regarding their moderation model may be explained by considering the direct effects personality traits had on end-of-life care planning. Certain traits may be associated with health-promoting behaviors and planning across all groups of the population, not just care recipients. That is, the effect of conscientiousness, agreeableness, and neuroticism on end-of-life care planning may be universal rather than reliant upon whether one is a recipient of care or not. Given that care recipients were no more likely than non-care recipients to complete formal end-of-life care plans, it is suggested that more attention be paid to assisting care receivers with obtaining the knowledge and skills necessary to be active participants in their end-of-life care planning. Certain personality traits should be considered when encouraging individuals to complete advance directives, noting that some personality traits may hinder planning.