End-of-Life Message Framing and Personal Tailoring Factors in Death-and-Dying Communication

Abstract

People in general view death as a taboo topic and tend to avoid discussing their own or others’ mortality. Talking about death and the dying, if done correctly, can have a positive impact on healthcare delivery and the bereavement process. The current paper focuses on encouraging a specific form of communication about death and dying: advance care planning (ACP) discussion. The research examined people’s reluctance to engage in conversations about end-of-life (EOL) health decision-making, with a focus on applying different message frames as a tool to overcome this barrier. I identified two message frames (i.e., ingroup and immortality message frame) that were hypothesized to improve participants’ ACP communication efficacy and decrease death anxiety. The ingroup message frame described death as a universal human experience whereas the immortality message frame described death as a life transition/graduation. In addition, I proposed two personal factors (i.e., previous contact experience with dying individuals and spirituality) that would be important for understanding which frames work with which people. For an audience who has had previous contact with dying people, the ingroup message frame would be predicted to be more effective; for a target audience with strong spiritual beliefs, the immortality message frame was hypothesized to be more effective. A pre-test/post-test experiment was conducted to examine how young adults (N = 384) react to two persuasive health promotion videos with different message frames: ingroup and immortality. The results showed that the health messages generated a null effect, that is, the framed messages did not mitigate people’s anxiety or communication efficacy, nor did they increase willingness to initiate ACP conversations. The results even revealed an unexpected outcome: watching health promotion videos decreased participants’ willingness to initiate ACP conversations in all experimental conditions. However, the results support the broader idea of integrating tailoring approaches into message framing. For highly spiritual people, using an immortality message frame makes them more likely to begin ACP conversations than low spiritual people. For people who have never had contact experiences with death-and-dying individuals, using an ingroup message frame makes them less likely to start ACP conversations than people who have had the contact experience, and this effect is due to a decrease in the no-contact participants’ communication efficacy. A follow-up analysis with homogeneous sub-group (adults 30 and younger) and only post-test perceptions showed that among people who had had previous contact with dying individuals, the ingroup message frame positively influenced communication efficacy, which led to a greater willingness to initiate ACP conversations. A future application for this line of research is to 1) test sleeper effects of messages promoting ACP discussion, 2) expand the study to test the interpersonal level interaction, and 3) incorporate different cultural beliefs as predictors.