Advance care planning (ACP) is the process of communicating about end-of-life (EOL) care with loved ones. Due to the deadly nature of COVID-19, ACP is vital. Unfortunately, fewer than 30% of American patients engage in ACP. In addition to low motivation, people experiencing death anxiety (DA) similarly avoid ACP. This finding coincides with predictions from terror management theory (TMT) that people avoid DA-arousing behaviors. Guided by the theory of planned behavior (TPB) and the health belief model (HBM), we posited COVID-19 risk perceptions would be positively associated with determinants of health behavior, including intention to share and ask loved ones about EOL wishes, as well as the associated attitudes, norms, and level of perceived behavioral control regarding ACP. Guided by TMT, we posited that DA negatively mediated relationships between COVID-19 risk perceptions and these behavioral determinants. An MTurk participant sample (N = 522) completed a survey about COVID-19 risk perceptions, DA, and health behavior determinants in the context of ACP. Results indicate COVID-19 risk perceptions were rarely directly related to these determinants. However, results of PROCESS mediation models examining the role of DA in these relationships reveal a different picture. While direct relationships were rarely significant, DA negatively mediated most relationships between COVID-19 risk perceptions and behavioral determinants. Our results indicate DA demotivates EOL communication during the COVID-19 pandemic; a concerning yet important finding due to the increased importance of ACP in the context of a deadly disease like COVID-19.

预先护理计划 (ACP) 是与亲人交流临终 (EOL) 护理的过程。由于 COVID-19 的致命性，ACP 至关重要。不幸的是，只有不到 30% 的美国患者参与 ACP。除了低动机之外，经历死亡焦虑 (DA) 的人同样会避免 ACP。这一发现与恐怖管理理论 (TMT) 的预测一致，即人们会避免引起 DA 的行为。在计划行为理论 (TPB) 和健康信念模型 (HBM) 的指导下，我们假设 COVID-19 风险认知与健康行为的决定因素呈正相关，包括分享和询问亲人有关 EOL 愿望的意愿，以及作为与 ACP 相关的态度、规范和感知行为控制水平。在 TMT 的指导下，我们假设 DA 对 COVID-19 风险认知与这些行为决定因素之间的关系产生负面影响。一个 MTurk 参与者样本（N = 522) 在 ACP 的背景下完成了一项关于 COVID-19 风险认知、DA 和健康行为决定因素的调查。结果表明，COVID-19 风险认知很少与这些决定因素直接相关。然而，检查 DA 在这些关系中的作用的 PROCESS 中介模型的结果揭示了不同的画面。虽然直接关系很少显着，但 DA 对 COVID-19 风险认知和行为决定因素之间的大多数关系产生了负面影响。我们的结果表明 DA 在 COVID-19 大流行期间削弱了 EOL 沟通；由于 ACP 在 COVID-19 等致命疾病的背景下越来越重要，因此这是一个令人担忧但重要的发现。