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i Acknowledgments iii List of Tables  viii List of Figures  ix Chapter One: Introduction  1 What is a Good Death?  3 End-of-Life Planning Strategies  5 Informed Consent and Self Determination  6 Patient Self Determination Act  9 Medical Orders 11 Advanced Care Planning 12 Goals and Objectives  16 Implications for Practice, Policy, and Health Disparities Research  17 Chapter Two: Literature Review and Theory  19 The Experience of Death  19 The Medical Model of Dying  22 Illness Trajectories  26 Racial and Ethnic Minorities and End-of-Life Planning  28 Socioeconomic Status and End-of-Life Planning  33 Religion and End-of-Life Planning  35 Other Factors that May Influence Formal End-of-Life Planning  40 Age  40 Gender  43 Social Support and Family Structure  45 Region of Death  46 Illness Trajectories  47 Conceptual Model for Understanding Differences in Formal End-of-Life Planning . 48 How Does Race Influence Formal End-of-Life Planning?  49 How Does SES Influence Formal End-of-Life Planning?  51 How Does Religion Influence Formal End-of-Life Planning?  54 Other Characteristics that May Influence Formal End-of-Life Planning  57 Specific Aims and Research Questions  58 vi Specific Aim One  58 Specific Aim Two  59 Specific Aim Three  59 Significance 60 Chapter Three: Methods  62 Data Source  62 Measures  65 Dependent Variables  65 Formal End-of-Life Planning  65 Independent Variables  66 Race and Ethnicity  67 Socioeconomic Status  67 Religion  69 Demographic Predictors 71 Statistical Methods  76 Statistical Methods: Aim One  76 Statistical Methods: Aim Two  77 Statistical Method: Aim Three  77 Chapter Four: Results  79 Descriptive Characteristics of the Sample  79 Demographics  79 Socioeconomic Status  80 Religion  81 Results for Specific Aim One Race and Types of Formal End-of-Life Planning .... 84 Results for Specific Aim Two Socioeconomic Factors and Formal End-of-Life Planning  92 Results for Specific Aim Three Religion and Formal End-of-Life Planning  95 Chapter Five: Discussion, Limitations, and Conclusion  100 Racial and Ethnic Differences in Formal End-of-Life Planning  100 Race, Socioeconomic Status, and Formal End-of-Life Planning  105 Race, Religion, and Formal End-of-Life Planning  108 Implications for Policy  111 Health Policy  111 vii Education Policy  112 Marriage Equality  112 Implications for Sociology  113 Limitations  114 Future Research  117 References  120 Appendix A: Century Month  141 Appendix B: Marital Status by Race  142 Appendix C: Race and Education  143 Appendix D: Frequency of Attending Religious Services by Religious Preference .... 144 Appendix E: Importance of Religion by Religious Preference  145

The Effects of Race, Socioeconomic Status, and Religion on Formal End-of-Life Planning