How Should we Implement Psychiatric Advance Directives? Views of Consumers, Caregivers, Mental Health Providers and Researchers

Abstract

The aim of this study was to measure expert consensus on the implementation of Psychiatric Advance Directives (PADs) within the Veterans Health Administration. We conducted a two-round Delphi study with 55 panelists including consumers, caregivers, mental health providers and researchers. For a number of items where no positive or negative consensus was reached we found differences between the views of consumers and non-consumers, reflecting consumer's preferences for nonmedical settings for completion and assistance with completion independent of the treatment team. Thus, the principle of consumer choice that applies to MHAD content should also be applied to the process of completion offered.

Psychiatric Advance Directives as a complex and multistage intervention: a realist systematic review

“…2005). However, our review indicates that there is no sufficient evidence available to allow us to understand the whole intervention, and therefore, that the evidence on how PADs should be implemented is still incomplete, as suggested elsewhere (Henderson et al. 2010).…”

“…The realist systematic review is designed to examine what works, for whom, and how in a complex intervention, to test the integrity of the underlying theories, and finally to adjudicate between them (Pawson et al 2005). However, our review indicates that there is no sufficient evidence available to allow us to understand the whole intervention, and therefore, that the evidence on how PADs should be implemented is still incomplete, as suggested elsewhere (Henderson et al 2010). Further comparative studies will have to address the contextual issues of the intervention, for example, the care setting, or the whole care and legal system, in more detail.…”

Users’ and Health Professionals’ Values in Relation to a Psychiatric Intervention: The Case of Psychiatric Advance Directives

“…In particular, Henderson et al (2010) carried out a Delphi study with 55 experts (users and non-users) of several options and procedures for implementing PADs. Stakeholders in two different organisational and study contexts may differ in their views about some practical options.…”

“…However, with the exception of the last study cited, randomised clinical evaluations have had disappointing results, showing little or no significant differences between intervention and control groups for primary outcomes (Borschmann et al 2013;Campbell and Kisely 2009;Papageorgiou et al 2002;Thornicroft et al 2011). Their actual implementation and use during crisis episodes is still an issue (Henderson et al 2010;Srebnik and Brodoff 2003). This could explain why rates of uptake of PADs have remained low regardless of their type and why results obtained during clinical trials have been disappointing (Thornicroft et al 2011).…”

A lack of therapeutic engagement and consumer input in acute inpatient care planning limits fully accountable mental health nursing practice

“…; Walsh & Boyle ), and that they want strength‐based approaches based on concepts of recovery (Dobie, Bulla & Swanke ; Henderson et al . ; Rose ). The question to be asked, then, is why does this type of meaningful care planning not always occur in acute inpatient mental health settings?…”