The development of potential models of advance directives in mental health care

Atkinson, Jacqueline M.; Garner, Helen C.; Stuart, Susan; Patrick, Hilary

doi:10.1080/09638230310001627937

Cited by 12 publications

(11 citation statements)

References 12 publications

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“…The second set of expectations is the improvement of the quality of the therapeutic alliance between the user and the clinicians and possibly of the global relationships involving the user, the user’s family/friends and the clinicians (Summers & Barber 2003, Priebe & McCabe 2006). In this context, the PAD document is perceived as a tool for the exchange of information (Atkinson et al. 2003b).…”

Section: Resultsmentioning

confidence: 99%

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

Nicaise

Lorant

Dubois

2012

Health &Amp; Social Care in the Community

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Psychiatric Advance Directives (PADs) are documents that allow users with severe and chronic mental illnesses to notify their treatment preferences for future crisis relapses and to appoint a surrogate decision‐maker for a period of incompetence. Despite many supposed clinical and organisational benefits, their take‐up rate has remained very low and their clinical evaluation has given contradictory results for organisational outcomes. Intermediary results are available, however, which rely on different theoretical views about how PADs are supposed to work. We carried out a realist systematic review that considered the PAD as a multistage intervention including the definition of the document, its completion and its access and honouring. We identified the theoretical frameworks underlying this kind of intervention and examined the available evidence that supported or contradicted the expectations at each stage of the intervention. Forty‐seven references were retrieved, ranging from 1996 to 2009. Three frameworks underlie a PAD intervention: enhancement of the autonomy of the user, improvement of the therapeutic alliance and integration of care through partnership working. Although designed in the first place with a view to sustaining the user’s autonomy, results indicate that the intervention is more efficient within a therapeutic alliance framework. Moreover, much is known about the completion process and the content of the document, but very little about its access and honouring. The mixture of expectations makes the purpose of PADs unclear, for example, crisis relapse prevention or management, advance planning of long‐term or emergency care, or reduction in the resort to coercion. This may explain their low take‐up rates. Hence, frameworks and purpose have to be clarified. The shape of the whole intervention at each stage relies on such clarification. More research is needed, particularly on the later stages of the intervention, as the evidence for how PADs should be implemented is still incomplete.

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Section: Resultsmentioning

confidence: 99%

“…2004). They were also concerned with their liability and possible decisional conflicts in case of legally binding PADs (Atkinson et al. 2003b), with the administrative burden of the intervention (Papageorgiou et al.…”

Section: Resultsmentioning

confidence: 99%

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

Nicaise

Lorant

Dubois

2012

Health &Amp; Social Care in the Community

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“…This approach particularly influenced the development of facilitated PADs (f-PADs) in the United States (Swanson et al 2006a). In the second theoretical framework, a PAD intervention was expected to improve the quality of the therapeutic alliance between clinicians, users, and carers as a tool for exchanging information, facilitating mutual understanding, and support compliance with treatment (Atkinson et al 2003b;Henderson et al 2004Henderson et al , 2008Papageorgiou et al 2002). This second framework underlay the development of Joint Crisis Plans (JCP) in the United Kingdom (Henderson et al 2004(Henderson et al , 2009Thornicroft et al 2011).…”

Section: Introductionmentioning

confidence: 99%

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

Nicaise

Soto

Dubois

et al. 2014

Adm Policy Ment Health

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Although clinical and organisational benefits have been expected from Psychiatric Advance Directives (PADs), their take-up rates remain low and their evaluation disappointing. The endorsement of PADs by stakeholders is decisive for their use and understanding stakeholders' preferences for implementation is crucial. A Multinomial Discrete Choice analysis was carried out of options for designing, completing, and honouring PADs, with a view to enhancing user autonomy, therapeutic alliance, care coordination, and feasibility. Although autonomy underlies the whole process, the criteria determining options varied with the stage of the intervention. These criteria should be taken into account in future PAD intervention and evaluation processes.

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“…The decision to use a questionnaire rather than interviews was taken to try to achieve a wide coverage of views rather than the more in-depth interviews which lead to the development of the models [20]. Despite the low response rate, there is a wide range of responders and the majority of responses were detailed, thoughtful and often expressed what were clearly strongly held opinions.A number of respondents commented that just reading the questionnaire had made them think of new issues.…”

Section: ■ Methodology and Response Ratementioning

confidence: 99%