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Social and health determinants of end-of-life care quality

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TitleInfo
Title
Social and health determinants of end-of-life care quality
SubTitle
a multidimensional approach
Name (type = personal)
NamePart (type = family)
Luth
NamePart (type = given)
Elizabeth Anne
NamePart (type = date)
1976-
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Elizabeth Anne Luth
Role
RoleTerm (authority = RULIB)
author
Name (type = personal)
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Carr
NamePart (type = given)
Deborah S
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Deborah S Carr
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Advisory Committee
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chair
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NamePart (type = family)
Phillips
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Julie
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Julie Phillips
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Advisory Committee
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internal member
Name (type = personal)
NamePart (type = family)
Springer
NamePart (type = given)
Kristen
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Kristen Springer
Affiliation
Advisory Committee
Role
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internal member
Name (type = personal)
NamePart (type = family)
Idler
NamePart (type = given)
Ellen
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Ellen Idler
Affiliation
Advisory Committee
Role
RoleTerm (authority = RULIB)
outside member
Name (type = corporate)
NamePart
Rutgers University
Role
RoleTerm (authority = RULIB)
degree grantor
Name (type = corporate)
NamePart
Graduate School - New Brunswick
Role
RoleTerm (authority = RULIB)
school
TypeOfResource
Text
Genre (authority = marcgt)
theses
OriginInfo
DateCreated (qualifier = exact)
2017
DateOther (qualifier = exact); (type = degree)
2017-05
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2017
Place
PlaceTerm (type = code)
xx
Language
LanguageTerm (authority = ISO639-2b); (type = code)
eng
Abstract (type = abstract)
Providing high-quality end-of-life (EOL) care to the nearly 1.9 million older adults who die each year in the U.S. is a pressing concern for policy makers and health care professionals. Medical and public health literature examines the quality of care for dying patients by considering a single measure or a handful of measures separately and in an atheoretical manner. I conduct latent class analysis (LCA) on four waves of National Health and Aging Trends Study data to develop three statistically and conceptually distinct subtypes of proxy reported end-of-life (EOL) care quality that consider multiple dimensions of care simultaneously. I find that between 20 and 25 percent of proxies report that decedents experience EOL characterized by unwanted symptoms and low quality care. The first analytic chapter uses these categories as an outcome measure to explore the extent to which social determinants of health and mortality extend to proxy perceptions of EOL care quality for 1,046 decedents. I find that the three primary axes of disadvantage in the U.S.-gender, race/ethnicity, and socioeconomic status-do not predict proxy perceptions of EOL care quality. However, hospice involvement, diagnosis with serious illness, dying in a location other than home, and more frequent hospitalization predict perceptions of care characterized by the presence of unwanted symptoms and poorer assessments on health care encounters and personal care measures. These findings have implications for how EOL care is assessed and suggest that policies to improve EOL care should target place of death, hospice involvement, and the needs of acutely and chronically ill persons. The second analytic chapter analyzes how proxy reporters’ evaluations of EOL care vary based on the decedent’s advance care planning (ACP) behavior, attitudes towards religious participation, and social characteristics (race/ethnicity, education, and sex). ACP does not predict EOL care quality using a multidimensional measure of quality. Greater importance of religious participation is associated with higher quality EOL care, and this relationship is stronger among individuals who complete ACP. Proxies for non-Hispanic whites report symptomatic, lower quality EOL care. Proxies for more religious decedents may associate these beliefs with these decedents’ increased acceptance of EOL and satisfaction with care. To the extent close family members share decedents’ religious attitudes, knowing a loved one’s preferences for EOL care may also facilitate increased satisfaction with care. The third analytic chapter explores how proxy reporters’ evaluations of EOL care vary based on the proxy reporters’ characteristics (familiarity with care, relationship to decedent). Proxy reporter’s familiarity with the decedent’s EOL care and relationship to the decedent predict their assessments of care quality. Results suggest caregiving roles and motivations for providing positive assessments should be carefully considered in understanding EOL care assessments, particularly for wives and paid caregivers. This dissertation uses LCA, a methodological approach to assessing EOL care quality that simultaneously accounts for multiple measures of care and how they co-occur among a sample of older adults. LCA provides an alternative method for assessing how multiple pieces of information move together and is potentially useful for understanding care for a variety of scenarios and settings. Attention to how social characteristics and processes relate to variation in perceptions of care among different subgroups can support practitioners and policy makers in targeting their efforts to improve care in a way that does not create or exacerbate disparities.
Subject (authority = RUETD)
Topic
Sociology
Subject (authority = ETD-LCSH)
Topic
Terminal care
RelatedItem (type = host)
TitleInfo
Title
Rutgers University Electronic Theses and Dissertations
Identifier (type = RULIB)
ETD
Identifier
ETD_7939
PhysicalDescription
Form (authority = gmd)
electronic resource
InternetMediaType
application/pdf
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text/xml
Extent
1 online resource (xi, 185 p. : ill.)
Note (type = degree)
Ph.D.
Note (type = bibliography)
Includes bibliographical references
Note (type = statement of responsibility)
by Elizabeth Anne Luth
RelatedItem (type = host)
TitleInfo
Title
Graduate School - New Brunswick Electronic Theses and Dissertations
Identifier (type = local)
rucore19991600001
Location
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NjNbRU
Identifier (type = doi)
doi:10.7282/T3MG7SCM
Genre (authority = ExL-Esploro)
ETD doctoral
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Rights

RightsDeclaration (ID = rulibRdec0006)
The author owns the copyright to this work.
RightsHolder (type = personal)
Name
FamilyName
Luth
GivenName
Elizabeth
MiddleName
Anne
Role
Copyright Holder
RightsEvent
Type
Permission or license
DateTime (encoding = w3cdtf); (qualifier = exact); (point = start)
2017-04-04 18:42:40
AssociatedEntity
Name
Elizabeth Luth
Role
Copyright holder
Affiliation
Rutgers University. Graduate School - New Brunswick
AssociatedObject
Type
License
Name
Author Agreement License
Detail
I hereby grant to the Rutgers University Libraries and to my school the non-exclusive right to archive, reproduce and distribute my thesis or dissertation, in whole or in part, and/or my abstract, in whole or in part, in and from an electronic format, subject to the release date subsequently stipulated in this submittal form and approved by my school. I represent and stipulate that the thesis or dissertation and its abstract are my original work, that they do not infringe or violate any rights of others, and that I make these grants as the sole owner of the rights to my thesis or dissertation and its abstract. I represent that I have obtained written permissions, when necessary, from the owner(s) of each third party copyrighted matter to be included in my thesis or dissertation and will supply copies of such upon request by my school. I acknowledge that RU ETD and my school will not distribute my thesis or dissertation or its abstract if, in their reasonable judgment, they believe all such rights have not been secured. I acknowledge that I retain ownership rights to the copyright of my work. I also retain the right to use all or part of this thesis or dissertation in future works, such as articles or books.
Copyright
Status
Copyright protected
Availability
Status
Open
Reason
Permission or license
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Technical

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2017-04-04T18:39:08
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2017-04-04T18:39:08
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