Comments on “How Do Our Patients Respond to the Concept of Psychiatric Advance Directives? An Exploratory Study from India”

Authors' Response to the Comments on “How Do Our Patients Respond to the Concept of Psychiatric Advance Directives? An Exploratory Study from India”

“…[1] The authors of the letter have observed that the study did not explore the attitude of the patients or the family members toward the concept of the advance directives (AD). [2] We agree that we have not discussed the attitude part of this paper as we have only focused on the treatment choice made by the patients.…”

“…We believe that all research on this subject, and on subjects related to attitudinal matters, suffer from potential limitations in external, internal, and ecological validity. [2] ADs are prepared by patients who may have a distrust of their caregivers or the mental health-care system, or by patients who have reason to believe that a particular treatment is harmful, perhaps based on experience or hearsay. So, what a study on ADs will find could be specifically influenced by past experiences of the study participants at the center in which the study is conducted.…”

“…Thus, the study has limited external validity. [2] Next, the manner in which ADs, psychiatric treatments, and other concepts are explained to study participants could influence their responses to enquiries about ADs. The influencing effect of the interviewer can be deliberate or unconscious.…”

“…So studies as conducted by Tekkalaki et al [1] could suffer from compromised internal validity. [2]…”