The influence of church leadership on completion of advance directives in the African American community

Advance directives are a means of honoring a patient's right to make decisions about their health care. Individuals of African American ethnicity are among the most reluctant to sign advance directives (Cort, 2004). Cultural attitudes affect end-of-life planning (Kwak & Haley, 2005), with religion and spirituality playing a more important role in end-of-life decisions for African Americans than for other ethnic groups (True et al., 2005). Very little research has been done to examine the influence of church leadership as a motivating force to encourage or discourage African Americans regarding completion of advance directives (Hill & Pargament, 2003).;This study is based on Airhihenbuwa's PEN-3 Model, which integrates culture as the motivation for health behaviors. Self-report instruments comprised of a Brief Multidimensional Measurement of Religiousness and Spirituality (BMMRS) and an advance directives scale were used to measure the influence of religious leadership and personal religiosity on African Americans' completion of advance directives.;A total of 44 church leaders and 436 parishioners from four churches within urban St Petersburg Florida participated in this study. Based on the multiple logistic regression analysis, results revealed that hypothesis 1 was rejected because there was no significant relationship between African American church leaders' attitudes and the attitudes of African American parishioners regarding the advance directive completion. Furthermore, results also revealed that African American church leaders' attitudes did not influence the completion of advance directives among African American parishioners, thus hypothesis 2 was rejected. Finally, the results of the multiple logistic regression analysis did not yield a significant relationship between parishioners' degree of measured religiosity and the completion of the advance directives; therefore, hypothesis 3 was also rejected.;However, when using a Pearson product correlation and simple logistic regression analysis there are positive relationships between the attitudes of African American church leadership and those of their African American parishioners regarding the completion of advance directives. Also, a relationship existed between the degree of religiosity and completion of advance directives.