Communicating Advance Directives in Physician-Patient Relationships: A Grounded Theory Approach of Experiences and Perceptions in the United States & Ghana
Siaw-Asamoah, Dorothy Maame
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This study explored the experiences and perceptions of individuals from two different groups and two different cultures about the topic of Advance Directives (AD) during clinical encounters. Framed by end-of-life discussions, physician-patient relationship scholarship and using grounded theory, physicians and patients from the United States (US) and Ghana (GH) were asked to share conversations about end-of-life. To examine the cultural framework about the topic, interviews (one-on-one) were conducted with US (n = 45) and GH (n = 45) patients, and US (n = 30) and GH (n = 30) physicians about AD discussions. Consistent with grounded theory approach and conceptual framework on AD, the data was analyzed by open, initial, axial and selective coding into concepts and categories. Subsequently, theory development, constant comparative procedure and the basic social processes from data analysis emerged until saturation. Results from the sample participants showed differences in communication about the topic by individualist and collectivist societies. However, there were similarities between Caucasian Americans and Ghanaians who have assimilated in the US on one hand and African Americans and Ghanaians living in Ghana on the other. This study also identified intervening factors explaining the challenges and strengths as well as contextual reasons such as the role of gender, religion and concept of disease in making decisions about AD. Consequently, the theoretical model illustrates the relationship in communicating AD between the groups and countries with suggestions on improving awareness (GH) and completion rates (US). Keywords: Advance Directive; End-of-life decision making; Grounded theory; Individualist & Collectivist society; Physician-patient relationship.