Competence to complete psychiatric advance directives: Effects of facilitated decision making.

Elbogen, Eric B.; Swanson, Jeffrey W.; Appelbaum, Paul S.; Swartz, Marvin S.; Ferron, Joelle C.; Dorn, Richard A. Van; Wagner, H. Ryan

doi:10.1007/s10979-006-9064-6

Cited by 33 publications

(39 citation statements)

References 28 publications

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“…Consistent with other research (35-37), length of stay was a critical predictor of all outcomes and remained so at five years. Treatment adherence (such as medication adherence) is a primary outcome examined in the psychiatric literature, and studies have examined the role of feared loss of housing, financial leverage, and threatened hospitalization in improving adherence (38)(39)(40). Adherence is also an important outcome in chemical dependency treatment.…”

Section: Discussionmentioning

confidence: 99%

Substance Use, Symptom, and Employment Outcomes of Persons With a Workplace Mandate for Chemical Dependency Treatment

Weisner

Lu²,

Hinman³

et al. 2009

Psychiatric Services

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Objective-This study examined the role of workplace mandates to chemical dependency treatment in treatment adherence, alcohol and drug abstinence, severity of employment problems, and severity of psychiatric problems.Methods-The sample included 448 employed members of a private, nonprofit U.S. managed care health plan who entered chemical dependency treatment with a workplace mandate (N=75) or without one (N=373); 405 of these individuals were followed up at one year (N=70 and N=335, respectively), and 362 participated in a five-year follow up (N=60 and N=302, respectively). Propensity scores predicting receipt of a workplace mandate were calculated. Logistic regression and ordinary leastsquares regression were used to predict length of stay in chemical dependency treatment, alcohol and drug abstinence, and psychiatric and employment problem severity at one and five years.Results-Overall, participants with a workplace mandate had one-and five-year outcomes similar to those without such a mandate. Having a workplace mandate also predicted longer treatment stays and improvement in employment problems. When other factors related to outcomes were controlledThe authors report no competing interests. for, having a workplace mandate predicted abstinence at one year, with length of stay as a mediating variable. NIH Public AccessConclusions-Workplace mandates can be an effective mechanism for improving work performance and other outcomes. Study participants who had a workplace mandate were more likely than those who did not have a workplace mandate to be abstinent at follow-up, and they did as well in treatment, both short and long term. Pressure from the workplace likely gets people to treatment earlier and provides incentives for treatment adherence.Treatment mandates are a major predictor of entry into chemical dependency treatment (1)(2)(3)(4)(5). In the public sector, individuals are often pressured to enter treatment by criminal justice or welfare agencies; in private programs the pressure is often from employers (1,3). Most research in this area has examined legal mandates, with treatment retention and rearrest as outcomes. Results are mixed, but outcomes are often similar to those of voluntary clients (5-12).Employee substance use problems are a major policy issue for employers, insurers, and health plans, as they affect large numbers of workers and impose a substantial financial burden on employers. Treatment mandates originate from employee assistance programs, unions, or employers (3,4,13). Few recent studies have examined how workplace mandates affect treatment outcomes, but earlier studies found that employees who were mandated to enter treatment and those who sought treatment voluntarily had comparable outcomes (14,15).Problem severity and motivation are robust factors affecting chemical dependency treatment outcome, possibly overriding effects of a mandate. Substance use and psychiatric disorders commonly co-occur among individuals in treatment (16-18), and these complex patients typically do less ...

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Section: Discussionmentioning

confidence: 99%

Substance Use, Symptom, and Employment Outcomes of Persons With a Workplace Mandate for Chemical Dependency Treatment

Weisner

Lu²,

Hinman³

et al. 2009

Psychiatric Services

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“…In many jurisdictions throughout the Commonwealth and United States, however, advance care plans can be overridden by mental health legislation. Elbogen et al (2007) emphasize the importance of competence as a central prerequisite to the implementation of a PAD, with the assistance of a third party (e.g. surrogate, trained facilitator) to ensure the competency of the service user when creating a PAD giving greater validity and credibility ).…”

Section: Literature Reviewmentioning

confidence: 99%

Service user and clinical perspectives of psychiatric advance directives in New Zealand

Thom

O’Brien

Tellez

2015

Int J Mental Health Nurs

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Advance care planning is becoming an increasingly important feature of health service provision. Although the New Zealand Mental Health Commission has advocated strongly for the provision of advance directives in mental health services, little is known about clinician or service user views on advance directives. The aim of the study was to survey the perspectives of service users and clinicians on the use of psychiatric advance directives. The study used an anonymous online survey to collect data from 110 mental health service users and 175 clinicians. Survey items included existing knowledge, preferred content and potential benefits of advance directives. Descriptive statistics and intergroup comparisons were conducted. Over 90% of service users and clinicians agreed that they support advance directives in mental health. There were similarities in the preferred content of an advance directive across the two groups, particularly regarding the notification of support persons, cultural support and preferred methods of de-escalation. Significant differences in opinion were found regarding the use of coercive measures and the ability of mental health legislation to override advance directives. The results indicate strong support for the use of advance directives within New Zealand mental health services, as well as for further research in the area.

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“…Another analysis from this clinical trial involved examining competence to complete PADs with a newly developed instrument that evaluates patients' understanding, appreciation, and reasoning ability applied to PADs and to specific treatment decisions contained in PADs . Elbogen et al (2007) found the manualized PAD facilitation significantly improved patients' competence to complete PADs, as well as patients' treatment decision-making capacity in general. The PAD facilitation intervention For these reasons, researchers, clinicians, and consumer-advocates have hypothesized that patients who write PADs will experience a greater sense of self-determination with respect to their mental health care (Backlar et al, 2001;Srebnik, 2004;Swanson, Tepper, Backlar, & Swartz, 2000).…”

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confidence: 90%

Effectively implementing psychiatric advance directives to promote self-determination of treatment among people with mental illness.

Elbogen¹,

Swanson²,

Swartz³

et al. 2007

Psychology, Public Policy, and Law

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Statutes on psychiatric advance directives (PADs) allow competent individuals to document instructions for future mental health treatment in the event of an incapacitating crisis. PADs are aimed at promoting a stronger sense of patient self-determination, considered a central tenet of psychosocial rehabilitation and recovery; however, it is unknown what factors (if any) lead psychiatric patients with PADs to experience this benefit long term. The current study involves examination of 1 year effects on perceived treatment self-determination among 125 people with mental disorders who completed PADs via a 1-on-1 facilitated PAD intervention. Descriptive analyses showed participants documented medically relevant information that would assist doctors in a crisis and participants reported a high level of satisfaction with the facilitated PAD intervention. Multivariate analyses demonstrated that increased sense of autonomy at 1 year was predicted by race, understanding PADs, and verbal memory. Results provide useful guidance for administrators and clinicians, suggesting that PADs show promise in helping empower people with mental illness, especially African-American clients. Further, findings indicate that optimal implementation of PADs will be achieved when facilitated intervention assists people with mental illness to better understand what PADs are and to remember they have a PAD at the time they are experiencing a psychiatric crisis. Legislation aiming to promote advance care planning and treatment self-determination among people with mental illness has proliferated in recent years. In the United States, laws defining psychiatric advance directives (PADs) have been passed in 25 states, allowing competent persons to document advance instructions for their future mental health treatment or to designate a health care agent to make decisions for them, in the event of an incapacitating psychiatric crisis (Appelbaum, 2004;Srebnik & La Fond, 1999;. In addition to recognizing the potential benefits of PADs, many states are beginning to recognize legal obligations under the federal Patient Self-Determination Act of 1991, which includes informing all hospital patients that they have a right to prepare advance directives and-with certain caveats-that clinicians are obliged to follow these directives (Hoge, 1994). As such, federal law helps ensure that people with mental illness, in whatever state they live, can use medical advance directives to specify mental health treatment preferences or to assign proxy decision makers for mental health decisions.If followed by treatment providers, PADs can help patients gain better access to the types of treatment that work best for them, especially during times when they are most in need of care but least able to speak for themselves (Backlar, McFarland, Swanson, & Mahler, 2001;Joshi, 2003;Vuckovich, 2003). Further, the very exercise of preparing a PAD and discussing it with a mental health professional may enhance therapeutic alliance and improve treatment engagement (Atkinson &...

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Competence to complete psychiatric advance directives: Effects of facilitated decision making.

Cited by 33 publications

References 28 publications

Substance Use, Symptom, and Employment Outcomes of Persons With a Workplace Mandate for Chemical Dependency Treatment

Substance Use, Symptom, and Employment Outcomes of Persons With a Workplace Mandate for Chemical Dependency Treatment

Service user and clinical perspectives of psychiatric advance directives in New Zealand

Effectively implementing psychiatric advance directives to promote self-determination of treatment among people with mental illness.

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