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Reducing barriers to completing psychiatric advance directives.

Richard A Van Dorn¹, Jeffrey W Swanson, Marvin S Swartz

¹College of Social Work, Justice, and Public Affairs, Florida International University, University Park Campus, 11200 SW 8th Street GL 484, Miami, FL 33199, USA. richard.vandorn@fiu.edu

Administration and Policy in Mental Health

|July 18, 2008

Summary

A facilitated intervention significantly reduced barriers to completing psychiatric advance directives (PADs), empowering individuals in mental health treatment planning. While PAD barriers decreased, further system-level changes are needed for complete elimination.

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Area of Science:

Mental Health Law and Ethics
Health Services Research
Psychiatry

Background:

Psychiatric advance directives (PADs) are crucial for individuals to plan future mental health treatment.
Barriers to completing PADs are not well understood, hindering their widespread adoption.
This study investigates an intervention aimed at reducing these barriers.

Purpose of the Study:

To examine the effect of a facilitated intervention on reducing barriers to PAD completion.
To assess barriers related to PAD documents and external support.
To understand the impact of these barriers on PAD completion rates.

Main Methods:

A randomized controlled trial was conducted with patients assigned to a facilitated PAD session or a control group.
Barriers were assessed at baseline, 6 months, and 1 year post-intervention.
Statistical analyses were used to compare barrier levels between groups and assess their predictive value for PAD completion.

Main Results:

No significant baseline differences in barriers were observed between the groups.
The facilitated intervention group showed significantly lower levels of both PAD document and external support barriers at follow-up.
Assessed barriers were found to be predictive of successful PAD completion.

Conclusions:

Structured facilitation effectively reduces barriers hindering psychiatric advance directive completion.
The intervention, while beneficial, did not completely eliminate all barriers to PADs.
System-level modifications may be necessary to further reduce barriers and promote PAD completion.