Understanding Joint Decision Making And Interpersonal Processes Among Older Adults With Chronic Pain
This dissertation compiles three papers that focus on the social context of chronic pain. Chapter 1 presents a conceptual framework of hypothesized risk factors for adult children of parents with chronic pain. The proposed framework is based on prior literature and theoretical models that highlight the interpersonal effects of chronic illness and pain on family relationships. The following two chapters explore older adults' social networks beyond the family context, and focus explicitly on decision making about pain treatment. The study presented in Chapter 2 employed in-depth interviews to investigate the social and decisional preferences of ethnically diverse (Hispanic and non-Hispanic White) individuals with chronic pain conditions. Qualitative content analysis was used to identify key themes in participants' responses. Results revealed that, when making treatment decisions, older adults prefer to involve emotionally reassuring social partners and peers with similar pain conditions or treatment experiences. Overall, participants' perceptions of their treatment decision making processes were more positive when the support they received matched the support they desired. The study presented in Chapter 3 employed survey methods to investigate the types (informational, emotional, instrumental) and sources (e.g. physician, relative) of decision support that individuals desire and receive when considering total joint replacement (TJR). Guided by theoretical frameworks from psychology and social gerontology, I examined the social structural (relationship to the patient) and experiential characteristics (having had TJR) that influence decision support preferences among TJR candidates. In parallel, I hypothesized that there would be an age-graded preference for emotional rather than informational support. Finally, I investigated whether higher congruence in desired and received support is linked with respondents' decisional conflict and certainty. Multilevel models showed that healthcare providers, family members, and individuals who had undergone prior TJR were key sources of decision support. There were no age differences regarding the types of support individuals desired and received. Overall, greater congruence in emotional support desired and received was associated with reduced decisional conflict, whereas greater congruence in practical support desired and received was associated with greater willingness to undergo surgery. The final chapter draws connections between the three papers and proposes directions for future research.
interpersonal relationships; decision making; gerontology
Pillemer,Karl Andrew; Reid Jr,M Carrington
Ph. D., Developmental Psychology
Doctor of Philosophy
dissertation or thesis