TABLE 5.

Processes used by participants to engage in ACP

Theme	Representative Quotation
Cognitive/emotional:
Thinking about recommendations made by clinicians or loved ones	Pressure, pressure, people start putting pressure on you, start walking around behind you talking about which way you are going, you know what I mean?
Thinking about support available from loved ones	I really think you should let [family members] be aware [of your wishes] so that if you do become sick, you need that support, family support.
Reflecting on experiences of others	A friend of mine helped me decide something [about preferences regarding treatment].
Recognizing susceptibility and need for ACP	When you are lying in the hospital, you kind of think about what your family is going to do…. Who is going to make the decisions? You decide that you are going to do whatever you possibly can.
Reflecting on positive consequences	I think it time that I do some things for my kids' sake, for my family, and for myself, too.
Considering who would make best surrogate	I don't feel that my daughter will make a decision quickly, and my son-in-law will.
Behavioral:
Seeking out information regarding ACP	I read stuff like this in the newspaper, question-and-answer things. I might be in a doctor's office and pick up a magazine, and it will be on a subject like what we are talking about now..
Assessing loved ones' readiness to communicate	I pick and choose. There are certain ones I tell [about my wishes]. The reason I do that is they have a little body language speak back to me.
Tailoring communication to loved ones	My daughter would cry…. It would be up to me to put it to her in such a way so I could eliminate all that crying.