Susana Lauraine McCune, Psy.D. is a 2015 graduate of the PsyD Program in Clinical Psychology at Antioch University, Seattle.

Dissertation Committee:

  • Phillip Cushman Ph.D., Committee Chair
  • Mary Weineke, Ph.D., Committee Member
  • Judith Gordon, Ph.D., Committee Member


Advance care planning, advance directives, end-of-life care, psychology, relational psychoanalysis, compassion, communication, hermeneutics, Interdisciplinary Relational Model of Care, aging, gerontology, health care, health education, medical ethics

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Despite a general agreement across health care disciplines that Advanced Care Planning (ACP) and Advanced Directives (ADs) add important elements to a patient's end-of-life care desires, and can inform their loved ones and advocates, help create ease of mind, and enhance quality of care, they continue to remain significantly underused. More than half of Americans transition to chronic and terminal illness without having completed them. The aim of this study was to increase the frequency and enhance the quality of communication about Advance Directives and Advance Care Planning within the clinical relationship. The resulting Interdisciplinary Relational Model of Care (IRMOC) can help clinicians engage in more frequent and effective communication about ADs and ACP. This ontological hermeneutic study considered scholarly and professional, practice-based health services literature, along with juridical, legislative, policy, and philosophical texts that have informed previous models of care. Tacit and explicit phenomena, conditions, and practices of communication about ADs and ACP in the patient-clinician relationship were identified. In response to the phenomena, conditions, and practices identified in this study the IRMOC was formulated and applied to communication about Advance Directives and Advance Care Planning in the patient clinician relationship. The IRMOC was then expanded, made more nuanced, and contextualized within the overall philosophical, theoretical, and practical frameworks that informed the model. The electronic version of this dissertation is at OhioLink ETD Center,