Access note: Some of the items in this collection are restricted to campus access only. Off-campus Daemen users can download items from this collection by the following link to log into our proxy server with your Daemen username and password.

Date of Award

Spring 2020

Document Type


Degree Name

Master of Science in Nursing (MSN)



Thesis Committee Chairperson

Janice Hobba-Glose DNS, MSN, RN

Second Reader

Mary Frey MSN, RN


Background: Advance directives have evolved throughout the years and are essential for individuals to possess. Advance directives allow you to specify your wishes regarding medical and life-sustaining treatments. However, the decision to complete an advance directive can be difficult. To face one’s own mortality is frightening for most individuals, especially when you are young and are considered healthy. These discussions should start early and with your primary care physician. Even with all the advancements and education regarding advance directives, not everyone has one.

Purpose: This research study was conducted to learn what the barriers and facilitators primary care patients have for not discussing or completing an advance directive with their primary care provider.

Methods: A quantitative descriptive anonymous survey design was employed for this study. A convenience sample of 66 individuals was recruited from a private primary care office in Western New York that specializes in internal medicine. Descriptive statistics were used to analyze the data. The Advance Directive Attitude Survey (ADAS) was utilized for this study which measures an individual’s attitude towards advance directives. The survey data is quantitative/categorical in nature and was analyzed using a Chi-square (non-parametric) data analytic procedure using SPSS and Microsoft Excel. The theoretical framework utilized was the Transtheoretical Model of Change by Prochaska and DiClemente.

Results: A total of 66 individuals participated in this study, 19 were males (28.8%), 46 were females (69.7%), and one participant who preferred not to reveal their gender (1.5%). Of the 66 participants, 47.0% (n=31) have an advance directive and 53.0% (n=35) do not. Of the 47.0% (n=31) with an advance directives, 22.6% (n=7) are men, 74.2% (n=23) are women, and 3.2% (n=1) preferred not to reveal their gender. Most of the participants in this research study were aged 46-65 years old (n=34, 51.6%) with a mean age of 51.06, had incomes of $25,000-$74,999 (n=34, 51.4%), their highest level of education was High School/GED (n=30, 45.5%) and most participants were 6 Caucasian/White (n=59, 89.4%). All the males with an advance directive were Caucasian/White (n=7, 100.0%). No African American/Black or Hispanic/Latino males have an advance directive. Most of the females with an advance directive were Caucasian/White (n=22, 95.7%), followed by one female only (n=1, 4.3%), who was Hispanic/Latino. No African American/Black females have an advance directive. Chi-square analysis of gender comparisons with the ADAS survey and its subscales shows that females more than males, feel having an advance directive has a positive effect on their family.

Conclusions/Implications for Practice: The data collected shows that just a little over a half of the participants do not have an advance directive which goes along with the information researched in the literature review. Females more than males, find having an advance directive as positive. Limitations to this study include a small sample size in one geographic area that did not provide a more diverse population. Recommendations for further research include conducting the study with the ADAS at other primary care offices in several different geographical areas of WNY to obtain a more diverse population of men/women, ages, and race/cultures. The proper setting to discuss and complete an advance directive is with your primary care provider. Utilizing the Transtheoretical Model of Change, education to primary care patients and their families can be tailored to the stage of learning they are in, so they can better understand and complete an advance directive starting when they are young and healthy and updating periodically, especially with each change in medical condition.