Dissertations & Theses (Open Access)

Date of Award

Spring 5-6-2022

Degree Name

Doctor of Philosophy in Nursing (PhD)


Constance Johnson, PhD

Second Advisor

Geri L. Wood, PhD

Third Advisor

Luba Yammine, PhD

Fourth Advisor

Donna S. Zhukovsky, MD


Background: Advance care planning (ACP) is a process that supports individuals at any stage of health in understanding and sharing their personal values and goals pertaining current or future medical needs with their families and healthcare providers. Although ACP is applicable to adults of any age and any stage of the health continuum, it is widely associated with older or terminally ill populations, and the need for end-of-life (EOL) planning in healthy young adults is generally found unnecessary. The National Institutes of Health supports the expansion of ACP research in understudied populations. Investigating ACP in healthy young adults support such efforts.

Specific Aims: The specific aims were: (1) examine ACP engagement in healthy young adults, ages 18-25 using a psychometrically validated instrument and (2) explore the relationship between ACP engagement and demographic and socio-economic factors in healthy young adults.

Methods: This study is a cross-sectional design using a 30-item questionnaire which collected demographic and socioeconomic data, assessed prior exposure to ACP and EOL experiences and used the validated ACP Engagement Survey to measure ACP readiness. The questionnaire was available online and promoted through social media. Of the 131 participants, 100 met inclusion criteria (n = 100). A series of independent samples t-tests were performed, ACP engagement score (ACPES) being the continuous dependent variable for all dichotomous independent variables. One-way ANOVAS were performed with ACP as the continuous dependent variable, for any independent variable with three or more levels. Lastly, a multiple linear regression was calculated where continuous and dichotomous variables were treated as the predictor variables and ACP was treated as the outcome variable.

Results: Mean ACPES was 2.3 (SD = .90, range 1-5). One variable was found to be significant (t(98), 4.960, p = .000) for ACPES: those who had ‘heard’ (ACPES M = 2.73, SD, .961) and had ‘not heard’ ( ACPES M = 1.93, SD = .643) of ACP prior to completing the questionnaire. The difference between those who had and had not heard of ACP was significant. ‘Having heard’ of ACP accounted for 30.4% of the score variance.

Conclusion: Overall ACP engagement is low in healthy young adults. Demographic and socioeconomic factors explored in the descriptive analysis were similar with findings in prior ACP literature. One significant factor associated with increased ACP engagement was identified: having had prior exposure to ACP. Future studies with larger samples and expanded sampling methodology are needed to extend these findings and support the design and testing of interventions designed to support early ACP engagement in healthy young adults.

Key Words: advance care planning, young adults, engagement, readiness, health, planning, end of life, advance directives


Advance care planning, young adults, engagement, readiness, health, planning, end of life, advance directives

Included in

Nursing Commons



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