The Death Message Processing Model: A Mixed Methods Evaluation of an Intervention to Motivate Advance Care Planning



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This study examined the use of humor (including profanity-laced humor) in persuasive communication promoting end-of-life (EOL) advance care planning (ACP). Based on lay theories from media experts in the “death positive movement” (DPM) and relevant social scientific theories (i.e., theory of planned behavior, terror management theory, humor theories, and expectancy violations theory), a Death Message Processing Model (DMPM) was proposed. The model was developed and tested through three phases of empirical research. Phase 1 consisted of in-depth interviews with DPM experts (N = 13) regarding how/why death humor works. Some themes from this phase included positive expectancy violation, tension release, younger generations prefer death humor, irreverent people prefer death humor, and religious people will not enjoy death humor. Phase 2 was an experiment with Amazon MTurk workers (N = 695) to assess responses to three podcast clips (i.e., non-humorous, clean humorous, profane humorous) about ACP. Results indicated that humorous (versus non-humorous) messages yielded lower positive expectancy violation and perceptions of speaker/message effectiveness. Humorous messages generated more positive emotional responses, however. In comparison to Christians, atheists preferred profane humor but rated clean humor less favorably. Moreover, people from younger (versus older) generations preferred humor to non-humor. Likewise, people who use less (versus more) profanity preferred humor over non-humor. Although significant differences were found for message response variables, experimental manipulations failed to elicit differences in death anxiety, communication apprehension about death, attitudes towards ACP, norms about ACP, perceived behavioral control towards ACP, or intention to engage in ACP. Overall, results indicated that humor about ACP, especially profane humor, is a risky communication approach. In Phase 3, follow-up interviews with Phase 2 experiment participants (N = 9) were conducted. Thematic analysis findings both supported and contradicted experiment results. Themes included clean humor has broad appeal and explicit mortality reminders (i.e., memento mori) catch attention. Interestingly, re-exposure to the humorous podcast clips apparently increased ACP intentions for several (N = 3) participants, suggesting that humorous death messages, when combined with a more powerful interpersonal intervention, may yield increased ACP intention. Based on findings from Phases 2 and 3, the initial DMPM was revised and areas in need of further investigation are highlighted in the discussion. Theoretical contributions and practical implications of the current findings are also discussed.