Date of Award

Fall 12-2023

Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Priscilla Gazarian

Second Advisor

Gloria Cater

Third Advisor

Janice Foust, Sun Kim


Advance Care Planning (ACP) is the ability to allow individuals to define goals and preferences regarding future medical care and discuss them with healthcare providers and caregivers in the event of a loss of decision-making capacity. African Americans (AAs) often discuss their wishes with their family members and expect their family to make decisions on their behalf if they become incapacitated. The aims of this study were to determine the following: Is AA participation in ACP associated with demographic and family factors?  Is there an association between ACP participation and decisional conflict. Is there an association between prognostic understanding of an illness and decisional conflict? Is there a relationship between AAs participation in ACP and choice of aggressive end-of-life care (EOLC) vs. comfort care. A Qualtrics survey was administered on Prolific, a web-based platform to AAs. Descriptive statistics, multivariable logistic regression, linear regression, odds ratio and 95% CI were used to analyze the associations between ACP and the dependent variables. It was found that AAs who participated in ACP activities (i.e., those who had Durable Power of Attorney for Healthcare or Living Will and Advance Directive) had higher income and education levels. They were also more likely married or living with a partner and had less decisional conflict regarding EOLC decision making. Future studies should focus on helping healthcare providers develop strategies that facilitate discussions with patients and family regarding their wishes and preferences as pertains to their health. Keywords: African Americans, blacks, advance care planning, advance directives, decisional conflict.


Free and open access to this Campus Access Thesis is made available to the UMass Boston community by ScholarWorks at UMass Boston. Those not on campus and those without a UMass Boston campus username and password may gain access to this thesis through resources like Proquest Dissertations & Theses Global ( or through Interlibrary Loan. If you have a UMass Boston campus username and password and would like to download this work from off-campus, click on the "Off-Campus UMass Boston Users