Clinicians’ Attitudes Regarding Barriers to the Implementation of Psychiatric Advance Directives

Abstract

Psychiatrists, psychologists and social workers tend to perceive significant potential barriers to PADs, related to operational aspects of these professionals' work environment as well as certain clinical features of PADs for persons with severe mental illness. Additionally, legal defensiveness and general endorsement of PADs appear to shape perceptions of barriers to the effective implementation of PADs.

Reducing Barriers to Completing Psychiatric Advance Directives

“…Our intent in specifying these four barriers was to tap into two potential conceptualizations of barriers faced by consumers, specifically “barriers associated with the PAD documents themselves” (i.e., not understanding the document and not knowing what to say or write in the document) and “ barriers associated with external support for PADs ” (i.e., having no one trustworthy to make decisions and not having a clinician to trust). This conceptualization of barriers is theoretically consistent with our prior research on clinicians' perceptions of barriers to PAD implementation (Van Dorn et al, 2006b) where clinicians identified barriers related to the PAD documents and systemic barriers external to the PAD documents. For the current analyses, barriers ranged between zero and two for each of the two barriers and were assessed at baseline, one, six and twelve months.…”

“…In particular, these findings indicate that to a large extent, the facilitated intervention (Swanson et al, 2006b) worked by reducing these barriers to PAD completion. However, significant system-level change is required before PADs achieve their potential and become an accepted part of mental health treatment (Srebnik & Brodoff, 2003; Van Dorn et al, 2006b). …”

“…The discrepancy between consumers' demand for PADs and their actual completion of these legal documents may be due to the varied and substantial barriers to PADs facing both consumers of mental health services and the systems that treat them (Swanson et al, 2006a; Van Dorn, Swartz, Elbogen, Swanson, Kim, Ferron, McDaniel, & Scheyett, 2006b). On the one hand, clinicians report barriers related to the operational features of the work environment, including a lack of communication between staff and lack of access to the document.…”

“…On the one hand, clinicians report barriers related to the operational features of the work environment, including a lack of communication between staff and lack of access to the document. Clinicians also describe barriers related to clinical or treatment factors, including consumers' inappropriate treatment requests and desires to change their mind about treatment during crises (Van Dorn et al, 2006b). It is possible that these barriers have prevented clinicians from fully supporting consumers' completion of PADs.…”

Psychiatric Advance Directives and Social Workers: An Integrative Review

“…Clinicians report barriers related to the operational features of the work environment, including a lack of communication between staff and lack of access to the document. Clinicians also describe barriers related to clinical or treatment factors, including consumers’ potential inappropriate treatment requests and desires to change their mind about treatment during crises; however, barriers related to the work environment were endorsed at a higher rate than those related to clinical factors (Van Dorn, Swartz, Elbogen, et al, 2006). While clinicians have identified concerns that affect their willingness to support the completion of PADs or their implementation during a crisis, consumers have also identified multiple factors that make it difficult to complete PADs.…”