Framing Effects of Questions On End-of-Life Decisions Among Latino Older Adults

Background: Making end-of-life decisions is a difficult and painful experience, yet, very little is known about the views of Latino older adults toward directives at the end-of-life. This study examined how the presentation of end-of-life questions influenced Latino older adults in making decisions about their lives. The authors build on prospect theory, which deals with decision-making based on whether a situation is framed positively or negatively (Tversky and Kahneman, 2000). This decisional dynamic can have an influence on the choices relating to end-of-life directives depending on how the situation is framed. Methods: This study used quantitative methods using survey data. It analyzed responses to questions relating to resuscitation and life-support directives from the Decision Making at the End of Life in Mexican American Aged survey (N=110). Surveys were administered in English and Spanish. Logistic and OLS regression were employed to build the statistical model. Results: Significant framing effects were found in the presentation of end-of-life questions and the decisions Latino older adults made in relationship to their views about resuscitation and life-support in their own lives. Multiple regression results indicate that participants were more likely to choose one of the options provided in either resuscitation or life-support according to the order in which choices were presented (â = .27, p<.01). Conclusions and Implications: A major implication from these findings is that health providers can affect the choices of Latino older adults facing end-of-life issues. Social workers can implement culturally-appropriate strategies within health care systems to address differences in how this crucial information is presented. With the rapid growth in the Latino older adult population in the United States, comes an ethical imperative to better understand and respect their perspective about end-of-life issues.