Document Type



Doctor of Philosophy


Psychology, Clinical-Community

Date of Defense


Graduate Advisor

Kamila White, Ph.D.


Kamila White, Ph.D.

Zoë Peterson, Ph.D.

Ann Steffen, Ph.D.

Judith Skala, Ph.D., RN.


End-of-life communication between patients, their family members, and healthcare providers is essential to quality care at the end-of-life. Advance care planning is increasingly utilized to facilitate end-of-life communication, but heart failure patients in particular face numerous challenges to achieving adequate end-of-life communication. Extant literature has highlighted the inherent uncertainty in heart failure as a barrier to end-of-life communication as well as the role of time perspective on the experience of heart failure patients, but little empirical research has been conducted to examine the impact of these constructs. The sample included 168 participants with heart failure who were recruited online through ResearchMatch and the American Heart Association support forum. Correlational data did not support a relationship between uncertainty in illness and end-of-life communication, but revealed significant associations between end-of-life communication and two dimensions of time perspective (i.e., past-negative, present-hedonistic). In contrast, hierarchical regression analysis revealed that uncertainty in illness predicted unique variance in end-of-life communication, and two dimensions of time perspective (i.e., past-positive, future) moderated this relationship. At high levels of uncertainty in illness, past-positive and future orientations were associated with increased end-of-life communication, but at low levels of uncertainty in illness, past-positive and future orientations were associated with decreased end-of-life communication. Study limitations and clinical implications are discussed.