- State your health outcome of interest. (It could be the one you used for week #2 or another one.) Pick two key behaviors that are important factors leading to your health outcome. Explain the importance of these behaviors either for etiology, prevention, or intervention. (If none of the behaviors in the readings are important for your health outcome, suggest another behavior that is.)
My health outcome of interest is advance directive completion and compliance with said advance directive at the end of life. Two key behaviors related to this outcome is primary health care access and the support of a surrogate decision maker. The ideal time to begin advance care planning when a person has the full capacity to express their preferences for care when faced with life-limiting illness as well as the agency to complete a legal advance directive that documents stating their preferences (e.g. living will, POLST, etc). Access to a primary care provider that is knowledgeable and able to broach these difficult conversations is an important factor in completion of advance directives. Having the support of a surrogate decision maker (familial or otherwise) to enforce an individual’s wishes is also helpful. An advance directive can be used to guide health care when a patient loses decision making capacity but health professionals more often rely on a surrogate for interpretation or advocacy of end of life decision making.
2. Describe how you would study the role of one of the behaviors described for question #1 and your health outcome of interest. Incorporate a social factor (e.g. race/ethnicity, social exclusion, stress) in the study approach.
To examine the role of surrogate decision makers support, I would like to look at measurements of social capital and the existence of a surrogate decision maker at the end of life in the absence of an immediate relative. Health care decision making when a patient loses capacity usually defaults to a relative (e.g. spouse, children, siblings, parents). But when a patient does not have any known or preferred relatives, who makes these decisions? I would design a study that looked at some measurement of social capital (relationships, social networks) in patients that do not have family support and the existence or non-existence of a surrogate decision maker.
3. If key health behaviors (e.g. smoking, exercise, nutritious diet) are strongly influenced by neighborhood, income, and/or education, do we need to continue to study how these behaviors influence health outcomes? Why or why not?
I would say yes because key health behaviors also have a direct biological effect which cannot be separated from the social effect. We need to continue to study how biological factors and social factors work independently as well as synergistically.