title: An assessment of social diffusion in the Respecting Choices advance care planning program.
abstract: This study examines the potential social diffusion effects of the Respecting Choices advance care planning program administered in La Crosse, Wisconsin, since 1991. The program produces educational materials for patients, trains facilitators to help patients prepare for end of life, and ensures that advance directives are connected to patients' medical records. Using data from a survey of more than 5,000 White Wisconsin high school graduates in their mid-60s, we found that participants who were living in the La Crosse area were significantly less likely than their peers living elsewhere to have executed a living will or appointed a health care power of attorney. This pattern may reflect psychological reactance, where individuals reject a message or lesson when they perceive compliance as a threat to their autonomy. There was no evidence of social diffusion effects; participants who lived in the La Crosse region themselves or who had social network members residing in the area were no more likely than those with no known ties to the region to have engaged in advance care planning. Future studies should explore the processes through which individuals learn and share with others their knowledge of advance care planning.
authors.affiliation: Department of Sociology and Institute on Aging, Boston College, Chestnut Hill, Massachusetts 02467-3807, USA. Sara.Moorman.1@bc.edu
authors.forename: Sara M
authors.initials: SM
authors.lastname: Moorman
authors.affiliation: Department of Sociology and Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Carr
authors.affiliation: School of Nursing (Emerita), University of Wisconsin-Madison, Madison, Wisconsin, USA.
authors.forename: Karin T
authors.initials: KT
authors.lastname: Kirchhoff
authors.affiliation: Gundersen Lutheran Medical Foundation, La Crosse, Wisconsin, USA.
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Hammes
mesh_terms: D032722:Advance Care Planning; D016223:Advance Directives; D000368:Aged; D001293:Attitude to Death; D002755:Choice Behavior; D005260:Female; D006266:Health Education; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010349:Patient Compliance / Q000523:psychology; D012932:Social Facilitation; D012944:Social Support; D013727:Terminal Care / Q000523:psychology; D014922:Wisconsin