Age and framing effects on decision making related to advance care planning.

Objectives Advance care planning (ACP) can promote autonomy and reduce burden at the end of life, yet many people avoid it. Drawing on prospect theory, life-span theories, and decision-making frameworks, this preregistered study examined whether message framing (gain, loss, neutral) influenced ACP b...

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Published in:Journals of Gerontology Series B: Psychological Sciences & Social Sciences Vol. 81; no. 8; pp. 1 - 13
Main Authors: Chen, Enna Y, Löckenhoff, Corinna E
Format: Article
Published: Oxford University Press / USA Aug2026
Subjects:
Online Access:View this record in EBSCOhost
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      dt: Aug2026
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          Chen, Enna Y
          Löckenhoff, Corinna E
        affil:
          Department of Psychology, Stanford University, Stanford, California, United States
          Department of Psychology, Cornell University, Ithaca, New York, United States
      su:
        United States
        Self-evaluation
        Defense mechanisms (Psychology)
        Age distribution
        Communication
        Affect (Psychology)
        Advance directives (Medical care)
        Patient participation
        Information-seeking behavior
        Statistical power analysis
        Scale analysis (Psychology)
        Research funding
        Statistical sampling
        Multiple regression analysis
        Descriptive statistics
        Intention
        Patient decision making
        Case studies
        Confidence intervals
        Data analysis software
        Regression analysis
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          Self-evaluation
          Defense mechanisms (Psychology)
          Age distribution
          Communication
          Affect (Psychology)
          Advance directives (Medical care)
          Patient participation
          Information-seeking behavior
          United States
          Marketing Research and Public Opinion Polling
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          Scale analysis (Psychology)
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          Intention
          Patient decision making
          Case studies
          Confidence intervals
          Data analysis software
          Regression analysis
      keyword:
        advance care planning
        Affect
        aged
        copyrightHolder:The Gerontological Society of America
        copyrightYear:2026
        decision making
        End-of-life planning
        Health decisions
        https://dx.doi.org/10.1093/geronb/gbag106
        Information avoidance
        inLanguage:en
        Message framing
        publisher:Oxford University Press
        sameAs:https://pubmed.ncbi.nlm.nih.gov/42301908/
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        terminally ill
        advance care planning
        Affect
        aged
        copyrightHolder:The Gerontological Society of America
        copyrightYear:2026
        decision making
        End-of-life planning
        Health decisions
        https://dx.doi.org/10.1093/geronb/gbag106
        Information avoidance
        inLanguage:en
        Message framing
        publisher:Oxford University Press
        sameAs:https://pubmed.ncbi.nlm.nih.gov/42301908/
        self-report
        terminally ill
      ab: Objectives Advance care planning (ACP) can promote autonomy and reduce burden at the end of life, yet many people avoid it. Drawing on prospect theory, life-span theories, and decision-making frameworks, this preregistered study examined whether message framing (gain, loss, neutral) influenced ACP behavioral intention, affective responses, and information avoidance, and whether these effects varied by age. Methods Five hundred U.S. adults aged 22–88 were randomly assigned to read a gain-framed, loss-framed, or neutral description of ACP. Participants completed self-report measures of ACP behavioral intention, affective responses, and information avoidance before and after the framing manipulation. Behavioral information avoidance was assessed only after the manipulation. Regression models tested framing effects and interactions with age. Results Participants in the loss-framed condition reported greater increases in ACP behavioral intention than those in the gain-framed condition. Age moderated the association between framing and behavioral information avoidance, such that older adults were more likely than younger adults to avoid ACP information in the gain condition, but not in the loss or neutral conditions. This age difference was evident for behavioral, but not self-reported, information avoidance. Discussion Loss framing may promote behavioral intention, whereas gain framing may increase information disengagement among older adults. This pattern suggests that ACP engagement may involve multiple decision stages and that framing may shape them through different mechanisms. The divergence between behavioral and self-reported avoidance highlights the value of assessing both forms of engagement. Findings also underscore the importance of considering life-span differences in ACP decision making.
      pubtype: Academic Journal
      doctype: Article
      src: R
    language: English
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