Knowledge and attitudes of Spanish mental health professionals towards advance healthcare directives

Abstract

Accessible summary What is known on the subject? AHDs in mental health are fundamental tools in advance care planning processes. It is an important method for involving mental healthcare users in clinical decisions and in providing effective healthcare based around user preferences. AHDs can be applied in situations in which the person may forfeit their legal capacity, according to the Convention on the Rights of Persons with Disabilities. However, the use of AHDs as described above is not yet a reality in Spain. What the paper adds to existing knowledge? The present study surveys the knowledge and attitudes of mental healthcare providers towards AHDs in clinical practice. Although providers had a moderate–low level of knowledge about AHDs, they presented positive attitudes towards them. What are the implications for practice? The use of AHDs in mental healthcare practice poses challenges to the Spanish mental healthcare system. Acquiring up‐to‐date data on the knowledge and attitudes of providers towards AHDs allows organizations to address aspects of their service that require reinforcement. This data could also be used by other countries just starting to use AHDs, as an initial step towards supporting the implementation of a multistage intervention process. More in‐depth training for providers would help improve their competence to implement or honour the statements set out in AHDs, the related legal and ethical issues, and liability issues related to their implementation. The Spanish mental healthcare system requires structural changes so that providers can embrace new ways of relating to users and to organize partnerships and a continuity of care centred on user preferences. Abstract IntroductionAdvance healthcare directives (AHDs) in mental health offer important information regarding service users’ preferences. However, whether AHDs are truly understood by providers is questionable. AimTo survey the knowledge and attitudes of mental health professionals towards AHDs and examine any associations with sociodemographic and occupational variables. MethodWe cross‐sectionally surveyed the knowledge and attitudes of 113 mental health professionals by using two validated questionnaires. ResultsParticipants showed very positive attitudes and high levels of knowledge about the conceptual definition and application of AHDs in clinical practice but their knowledge of the legalities, procedure and registration of AHDs was poor. Working in a community, having a career specializing in mental health or having personally signed an AHD was associated with enhanced knowledge about them. Moreover, female sex or employment as an auxiliary nursing‐care technician was associated with stronger positive attitudes. DiscussionLegal and structural changes will be needed to implement AHDs in Spain and to promote competence among healthcare providers in order to include AHDs in everyday practice. Implications for practiceThe Spanish mental healthcare system requires legal and structural changes and must improve healthcare p...

Emergency Healthcare Providers’ Knowledge about and Attitudes toward Advance Directives: A Cross-Sectional Study between Nurses and Emergency Medical Technicians at an Emergency Department

“…Consistent with our results, Taiwanese nurses who provided care for patients with chronic illnesses showed a moderately low level of knowledge about ACP, with a correct response rate of 53% [24]. In particular, nurses' knowledge about legitimate process for preparation of ADs and healthcare proxies was not yet well recognized [24,26,43], while conceptual knowledge and application for ADs among mental health professionals were high [26]. In another study, knowledge about ADs of medical (45%) and nursing professionals was also moderately low [27], while among the medical specialists, legal knowledge about withholding/withdrawing LSTs of palliative care specialists and geriatricians was higher than that of other specialists [30].…”

“…Healthcare providers' knowledge and attitudes toward ADs are important modifiable factors [24,26] that could facilitate the patients' decision about and enhance the effective implementation of ACP and ADs [23,28,39]. Emergency healthcare providers were challenged for the implementation of end-of-life care of terminal patients at the emergency department concerning an AD itself, its availability in medical records [40], accuracy, and stakeholders' disagreements [41].…”

“…Different measures of knowledge also prevent comparing our results and previous findings. Further, a wide variety in the level of knowledge about ACP and ADs exists according to the areas of practice or specialty/expertise [26,29,30]. Nonetheless, in a systematic synthesis of three survey studies that examined nurses' AD-related concepts, approximately 60% of knowledge was correct among nurses, with the knowledge of critical care nurses being higher than that of oncology and emergency care nurses [42].…”

“…Benefits associated with ACP and/or ADs have been well documented [16][17][18][19], while the utilization remains suboptimal or is delayed until death [20][21][22]. Among the barriers to the limited access, professional perspectives around ACP and/or ADs were reported to influence the patient's decision on beginning such care or implementing the procedure as desired [6,[23][24][25][26]. In particular, knowledge about and attitudes toward ACP and/or ADs were modifiable factors for increasing the likelihood of initiating ACP or AD use [23,27,28], while their knowledge and/or attitudes seemed to vary across the professions and were dependent on their areas of expertise [26,29,30].…”

“…Among the barriers to the limited access, professional perspectives around ACP and/or ADs were reported to influence the patient's decision on beginning such care or implementing the procedure as desired [6,[23][24][25][26]. In particular, knowledge about and attitudes toward ACP and/or ADs were modifiable factors for increasing the likelihood of initiating ACP or AD use [23,27,28], while their knowledge and/or attitudes seemed to vary across the professions and were dependent on their areas of expertise [26,29,30]. In one study that reported knowledge and attitudes among the healthcare professionals, more knowledge about and positive attitudes toward the law regarding the withholding/withdrawing of LSTs were noted among palliative care specialists and geriatricians compared to other specialists, while their knowledge deficit was still substantial [30].…”