Advance care directives (ACDs) are underutilized by Black American older adults and by members of many religious communities. Goals of study 1 were to replicate these findings and examine the hypothesis that religious affiliation moderates the influence of racial identity on ACD utilization. The goal of study 2 was to compare and contrast the effects of a culturally sensitive ACD versus a standard state directive on ACP engagement scores among Black Americans. In study 1, data represented 1281 Black and White Respondents from the Health and Retirement Study. Demographic variables included gender, race, ethnicity, religion, and relationship status. Other variables were cancer diagnosis, and medical comorbidity as defined by the presence of one or more of the following: hypertension, heart disease, lung disease, diabetes, stroke and arthritis. The criterion variable was presence of an ACD. In study 2, data represented 189 White and Black Americans recruited from MTurk and Prolific. Demographic and health variables were the same as in study 1 and the criterion variable was score on the Advance Care Planning Engagement Survey. Results of study 1 were older, more educated, non-Hispanic, and those of White race were more likely to have completed an advance care directive. Additionally, race and religious affiliation were independent predictors of ACD completion, and frequency of religious attendance was a significant predictor of ACD completion among Catholic respondents. Results of study 2 were race, religiosity, and group condition (Five Wishes vs. state directive) were not independent predictors of ACP engagement scores, however, physician trust did predict ACP engagement scores and was shown to differentially impact Black Americans in the State Directive condition only.


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Graduation Date





Paulson, Daniel


Doctor of Philosophy (Ph.D.)


College of Sciences



Degree Program

Psychology; Clinical Psychology


CFE0009848; DP0028156





Release Date

November 2028

Length of Campus-only Access

5 years

Access Status

Doctoral Dissertation (Campus-only Access)

Restricted to the UCF community until November 2028; it will then be open access.