The Content and Clinical Utility of Psychiatric Advance Directives

Srebnik, Debra; Rutherford, Lindsay Taggart; Peto, Tracy; Russo, Joan; Zick, Ellen; Jaffe, Craig A.; Holtzheimer, Paul E.

doi:10.1176/appi.ps.56.5.592

Cited by 117 publications

(95 citation statements)

References 19 publications

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“…Findings from these data, in addition to prior research (Backlar et al, 2001;Srebnik & Brodoff, 2003;Srebnik et al, 2005) indicate that clinicians' concerns that PADs will be used to refuse all treatment have largely been unfounded. Instead, it appears that PADs are likely to be feasible, useful, and in agreement with community standards of care.…”

Section: Discussionmentioning

confidence: 65%

Understanding the Personal and Clinical Utility of Psychiatric Advance Directives: A Qualitative Perspective

Kim¹,

Dorn²,

Scheyett³

et al. 2007

Psychiatry: Interpersonal and Biological Processes

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Section: Discussionmentioning

confidence: 65%

Understanding the Personal and Clinical Utility of Psychiatric Advance Directives: A Qualitative Perspective

Kim¹,

Dorn²,

Scheyett³

et al. 2007

Psychiatry: Interpersonal and Biological Processes

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“…It is also worth noting that the average number of refused medications was 1.5, while the average number of requested medications was 2.4. Some clinicians fear that psychiatric advance directives will enable patients with poor insight to refuse all treatment, even treatment that might be beneficial (38,45). However, in this study, individuals on average provided prior consent to more medications than they refused.…”

Section: Discussionmentioning

confidence: 99%

“…Content analyses of psychiatric advance directives have reported the frequency of medication requests and refusals in these documents (32–34). However, no previous studies have compared medications requested in psychiatric advance directives to those actually prescribed or examined whether receiving preferred medications improves medication adherence.…”

mentioning

confidence: 99%

Medication Preferences and Adherence Among Individuals With Severe Mental Illness and Psychiatric Advance Directives

Wilder¹,

Elbogen²,

Moser³

et al. 2010

Psychiatric Services

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Objective Psychiatric advance directives allow patients with severe mental illness to document their preferences for particular medications. This study investigated the role of psychiatric advance directives in treatment choice and medication adherence. Methods A total of 123 persons with severe mental illness recorded medication preferences in psychiatric advance directives. The authors compared medication preferences to prescribed medications over 12 months, determined concordance between preferred and prescribed medications, and examined the effect of concordance on medication adherence at 12 months. Results Participants requested a median of two medications in their psychiatric advance directives (range, zero to six) and refused a median of one medication (range, zero to ten). At follow-up, the number of medications requested in psychiatric advance directives that were currently prescribed increased by 27%. (Wilcoxon matched pairs, p<.001). After correcting for the number of medications listed in the psychiatric advance directive, a 10% increase in concordance remained significant (p<.001). Being prescribed at least one medication requested in the psychiatric advance directive predicted higher medication adherence at 12 months, after the analysis controlled for relevant covariates (odds ratio=7.8, 95% confidence interval=1.8–34.0). Conclusions Providing information about medication preferences in psychiatric advance directives may increase prescribing of patient-preferred medications even in noncrisis settings. Patients who were prescribed medications that they request in advance were significantly more likely to adhere to medications, supporting the benefit of patient participation in medication choice. Psychiatric advance directives appear to be a clinically useful conduit for communicating patient medication preferences.

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“…Or can they be invoked only after they are assessed as lacking capacity? The "after" scenario is not too ethically or legally controversial because the directive actually constitutes client participation in the care plan and establishes relevant "prior expressed wishes" (Bogdanoski, 2009;Srebnik et al, 2005;Swanson et al, 2006). Dubbed "a Ulysses contract" after the Greek fable about Ulysses, the "before" scenario is definitely controversial.…”

Section: Institutional Mechanismsmentioning

confidence: 99%

Ethics Related to Mental Illnesses and Addictions

Russell¹

2011

Bioethics in the 21st Century

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The Content and Clinical Utility of Psychiatric Advance Directives

Cited by 117 publications

References 19 publications

Understanding the Personal and Clinical Utility of Psychiatric Advance Directives: A Qualitative Perspective

Understanding the Personal and Clinical Utility of Psychiatric Advance Directives: A Qualitative Perspective

Medication Preferences and Adherence Among Individuals With Severe Mental Illness and Psychiatric Advance Directives

Ethics Related to Mental Illnesses and Addictions

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