Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation


Public Health



First Advisor

Dr. Joy M. Jacobs-Lawson

Second Advisor

Dr. John F. Watkins


Older adults increasingly face difficult decisions in life threatening contexts as they move closer to death, become more likely to be diagnosed with life threatening diseases, and encounter more death within their social network (Greenberg, 2011). The purpose of this research was to understand the effect of a life-threatening decision context centered around cancer, self-esteem, other individual difference factors and cancer experience on older adults’ decision making competence, and preferences for collaborative decision making.

Study participants were recruited through online circulation of the study recruitment flyer and in-person solicitations at meetings and other events at community locations (senior centers, civic group centers, and churches, etc.). Participants age 55-90 (N=202) were randomly assigned to either a mundane or life threatening condition and asked to complete the corresponding survey packet containing a measurement questionnaire. Analyses consisted of a series of analyses of variance (ANOVA) and regressions. The dependent variables were 3 major components of the DeBruin et al. (2007) Adult Decision Making Competence Scale: (a) Resistance to Framing, (b) Resistance to Sunk Cost Bias, and (c) Over/under confidence, in addition to a measure of Maximizing Tendency (Diab et al., 2008).

Analyses revealed mixed results. Decision context did have an effect on decision making competence, while self-esteem showed little effect. No main effects or interactions were found between decision context, self-esteem, and preferences for collaborative decision making. Individual difference factors did effect decision making competence, with future time perspective, risk tolerance, and ego-integrity emerging as significant predictors. Furthermore, compelling results emerged pertaining to the effect of previous cancer experience on decision making competence.

Results highlight the lasting effect of context and a previous cancer diagnosis on decision making competence and have implications in health care, psycho-oncology, and treatment decision making domains.