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The U.S. Congress passed the Patient Self-
Determination Act guaranteeing the individual s
legal right to decide the end-of-life care via the
mechanism of completion of Advance Directives in
1990. More than a decade after the Act, the
utilization of this legal right has seen no
significant change in the general population. The
purpose of this quantitative study was to identify
the variables that influence the decision-making
responses related to Advance Directives (ADs). A
path model applying Roy's concepts was developed for
the study. The sample consisted of a matched set of
938 participants.
The final path model showed that age and gender
significantly contributed to the number of hospital
and nursing home admissions. The number of hospital
and nursing home admission was significantly
associated with physical impairment. Physical
impairment had the greatest effect on the decision-
making responses. Those who were less likely to
continue working or do volunteer work were also less
likely to complete ADs. The soundness of the final
path model was confirmed by the decomposition of the
bivariate correlations.

Factors Influencing Decisions on End of Life Care: An Application of Roy's Model