A template for a psychiatric advance directive: Co-development and qualitative evaluation with key stakeholders

Area of Science:

• Mental Health Law
• Patient Autonomy
• Healthcare Policy

Background:

• Psychiatric Advance Directives (PADs) empower mental health service users to document treatment preferences for future crises.
• Accessible PAD templates are crucial for improving practical implementation in mental healthcare settings.

Purpose of the Study:

• To co-develop and evaluate a Psychiatric Advance Directive (PAD) template specifically designed for the German healthcare context.
• To ensure the template incorporates the needs and perspectives of key stakeholders, including service users and professionals.

Main Methods:

• A systematic review of PAD content and existing templates informed the initial prototype development.
• Co-development involved a lived experience council, focus groups with diverse stakeholders, and consultations with experts.
• Iterative refinement of the template occurred based on feedback from multiple rounds of evaluation.

Main Results:

• Stakeholders highly valued sections on personal values, preferred support, and supported decision-making.
• Recommendations included a crisis summary page, a 'well self' description, and post-inpatient care preferences.
• Discussions arose regarding the inclusion of decision-making capacity indicators, treatment settings, and de-escalation strategies.

Conclusions:

• The study successfully developed the first German Psychiatric Advance Directive (PAD) template through collaborative stakeholder engagement.
• The co-development methodology serves as a transferable model for creating context-specific PAD templates in other legal jurisdictions.