Age and framing effects on decision making related to advance care planning

Advance care planning (ACP) can promote autonomy and reduce burden at the end of life, yet many people avoid it. Drawing on prospect theory, life-span theories, and decision-making frameworks, this preregistered study examined whether message framing (gain, loss, neutral) influenced ACP behavioral intention, affective responses, and information avoidance, and whether these effects varied by age.

Five hundred U.S. adults aged 22-88 were randomly assigned to read a gain-framed, loss-framed, or neutral description of ACP. Participants completed self-report measures of ACP behavioral intention, affective responses, and information avoidance before and after the framing manipulation. Behavioral information avoidance was assessed only after the manipulation. Regression models tested framing effects and interactions with age.

Participants in the loss-framed condition reported greater increases in ACP behavioral intention than those in the gain-framed condition. Age moderated the association between framing and behavioral information avoidance, such that older adults were more likely than younger adults to avoid ACP information in the gain condition, but not in the loss or neutral conditions. This age difference was evident for behavioral, but not self-reported, information avoidance.

Loss framing may promote behavioral intention, whereas gain framing may increase information disengagement among older adults. This pattern suggests that ACP engagement may involve multiple decision stages and that framing may shape them through different mechanisms. The divergence between behavioral and self-reported avoidance highlights the value of assessing both forms of engagement. Findings also underscore the importance of considering life-span differences in ACP decision making.