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Qualitative Health Research, Vol. 13, No. 8, 1039-1062 (2003)
DOI: 10.1177/1049732303256554
© 2003 SAGE Publications

Meaning and Agency in Discussing End-of-Life Care: A Study of Elderly Veterans' Values and Interpretations

Amanda J. Young

VA Pittsburgh Healthcare System's Geriatric Research, Education, and Clinical Center (Grecc), Department of Neurology, University of Pittsburgh School of Medicine, Pennsylvania

Terri Ofori-Boateng

Metro Health Medical Center and the Cleveland Clinic, Ohio

Keri L. Rodriguez

Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pennsylvania

Judith L. Plowman

Pittsburgh Grecc, University of Pittsburgh School of Medicine, Pennsylvania

The authors of this exploratory study used textual analysis of transcribed interviews to examine the mental constructs that individuals form around advance care terminology and to learn how elderly veterans conceptualize the language used in the Veterans Administration advance directive. They found that respondents often negotiated meaning by drawing on rigid schemas, specific mental constructs already in place: The Lord's Will, Machine Talk, Being a Burden, and Being Productive. The authors also examined the transcripts for agency. In addition to assigning external agency for end-of-life care decisions, respondents often expressed a complex interaction of "self" and "other" agency. These results challenge us to develop communication methods that allow patients to claim agency and participate fully in decisions regarding their health care, especially at the end of life.

Key Words: end-of-life care • communication • geriatrics • veterans


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