Jeffrey W. Swanson|Marvin S. Swartz|Eric B. Elbogen|Richard A. Van Dorn|Joelle C. Ferron|H. Ryan Wagner|Barbara J. McCauley|Mimi Kim
Facilitated Psychiatric Advance Directives: A Randomized Trial of an Intervention to Foster Advance Treatment Planning Among Persons with Severe Mental Illness
Duke University|Duke University Hospital|Duke Medical Center
studies show high potential demand psychiatric advance directives low completion rates authors conducted randomized study structured manualized intervention facilitate completion psychiatric advance directivesa total 469 patients severe mental illness randomly assigned facilitated psychiatric advance directive session control group received written information psychiatric advance directives referral resources public mental health system completion advance directive structure content shortterm effects working alliance treatment satisfaction recordedsixtyone percent participants facilitated session completed advance directive authorized proxy decision maker compared 3 control group participants psychiatrists rated advance directives highly consistent standards community practice participants used advance directive refuse medications express preferences admission specific hospitals others although none used advance directive refuse treatment 1month followup participants facilitated session greater working alliance clinicians likely control group report receiving mental health services believed neededthe facilitation session effective method helping patients complete psychiatric advance directives ensuring documents contain useful information patients treatment preferences achieving promise psychiatric advance directives may require systemlevel policies embed facilitation instruments usualcare care settings