End-of-Life Treatment Preferences of Persons With Serious Mental Illness

Foti, Mary Ellen; Bartels, Stephen J.; Citters, Aricca D. Van; Merriman, Melanie P.; Fletcher, Kenneth E.

doi:10.1176/appi.ps.56.5.585

Cited by 49 publications

(93 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These questions, which are provided in Appendix A, were developed by the authors and/or adapted from previous surveys. 12,13 PAC-CF participants were asked to report on their experiences with different components of ACP. Questions were included on how they would like decisions about medical care to be made if they were to become too ill to make decisions on their own.…”

Section: Methodsmentioning

confidence: 99%

Advance Care Planning in Adults with Cystic Fibrosis

Sawicki

Dill

Asher

et al. 2008

Journal of Palliative Medicine

View full text Add to dashboard Cite

Background: Because many patients with cystic fibrosis (CF) continue to survive into adulthood, discussion of end-of-life care decisions between clinicians and patients becomes a crucial part of CF adult care. Advance care planning (ACP) promotes alignment of patient care at the end of life with an individual's goals, however minimal research exists on ACP in CF. Methods: We surveyed adults enrolled in the Project on Adult Care in Cystic Fibrosis (PAC-CF). We assessed experiences with ACP processes and communication and sought to identify factors associated with completion of an advance directive. Results: The mean age of respondents (n ϭ 234) was 34 years and the mean forced expiratory volume in 1 second (FEV 1 ) was 64% predicted. Seventy-four percent reported that they had spoken to someone, generally a family member, about the care they would want if they became too ill to make decisions for themselves. However, only 30% reported completing an advance directive. Although 79% reported feeling comfortable talking to their clinician about ACP, only 28% said that their CF clinicians have asked about ACP. Having specific wishes about treatment decisions (odds ratio [OR] 7.8, 95% confidence interval [CI] 1.9-32.1) and reporting that a clinician had discussed ACP (OR 4.4, 95% CI 1.5-12.6) were significantly associated with reporting the completion of an advance directive. Discussion: Though the majority of adults with CF report thinking about and communicating with family about advance care wishes, only a minority report completing an advance directive. Few adults with CF report being asked about ACP by their clinicians. Formulating specific wishes and discussing ACP with a clinician are strongly associated with completing an advance directive. Efforts to improve clinician communication with CF adults around ACP are needed to ensure that discussion of advance directives becomes an integral component of adult CF care.

show abstract

Section: Methodsmentioning

confidence: 99%

Advance Care Planning in Adults with Cystic Fibrosis

Sawicki

Dill

Asher

et al. 2008

Journal of Palliative Medicine

View full text Add to dashboard Cite

show abstract

“…Suggestions for medical care include multidimensional assessment, 25,43 using periods of symptom remission and increased lucidity to complete advance directives, discuss plans of care, and carry out physical examinations and tests; being alert to signs of physical illness, 25 anticipating needs, giving serious attention to complaints despite difficult behaviour 34,44 ; treating pain, 25,37 and continuing established medication regimens if they were successful. 6 Other recommendations include learning about SPMI and developing skills to address behavioural issues, 25 ; expectation of dysfunction and failure 5,6,24,25 ; lack of health care choices 4,5,24,27 ; estrangement from family, lack of continuity of supports, and for some, homelessness. 25 Alcohol-Related Disorder.…”

Section: Provision Of Carementioning

confidence: 99%

“…The research by Foti and colleagues 4,5,24,27 is important. The values, hopes, and goals of patients are at the heart of palliative care.…”

Section: Strengths and Limitations Of The Papersmentioning

confidence: 99%

See 1 more Smart Citation

Palliative Care for People with Severe Persistent Mental Illness: A Review of the Literature

Woods

Willison²,

Kington³

et al. 2008

Can J Psychiatry

136

View full text Add to dashboard Cite

A systematic overview of the literature on palliative care for people with severe persistent mental illness (SPMI) was conducted to inform clinical practice, research, and education. Empirical studies and nonempirical papers were included. Few empirical studies exist. There is even less information about the palliative care needs of, or the nature of palliative care provided to, people with SPMI. Mental health, primary care, and palliative care providers need to partner with people who have SPMI in developing and providing palliative care. The field of palliative care for people with SPMI is wide open and in need of methodologically sound studies that will help define the issues that exist for this vulnerable population. Recognizing the similarities between mental health and palliative care should lead to collaborative ventures and discussions in an attempt to address common and parallel issues.

show abstract

“…First, nursing home staff generally lack training to care for persons with serious mental illness (11) and may be uncomfortable with treating them because of concerns about possible dangerous and disruptive behaviors (7) and because staff may harbor stigma toward this population of residents (12). Second, health care providers may assume that persons with serious mental illness inevitably lose decisional capacity to participate in advance care planning (13,14); this is a common misconception that has proved stigmatizing (15–18). Finally, persons with serious mental illness who are under legal guardianship are likely to be prohibited from self-determining their medical and psychiatric treatments (19,20).…”

mentioning

confidence: 99%

Origination of Medical Advance Directives Among Nursing Home Residents With and Without Serious Mental Illness

Cai

Cram²,

Li³

2011

View full text Add to dashboard Cite

Objective-Nursing home residents with serious mental illness need a high level of general medical and end-of-life services. This study tested whether persons with serious mental illness are as likely as other nursing home residents to make informed choices about treatments through medical advance care plans.Methods-Secondary analyses were conducted with data from a 2004 national survey of nursing home residents with serious mental illness (N=1,769) and without (N=11,738). Bivariate and multivariate analyses determined differences in documented advance care plans, including living wills; "do not resuscitate" and "do not hospitalize" orders; and orders concerning restriction of feeding tube, medication, or other treatments.Results-The overall rates of having any of the four advance care plans were 57% and 68% for residents with and without serious mental illness, respectively (p<.001). Residents with serious mental illness also showed lower rates for individual advance care plans. In a multivariate analysis that adjusted for resident and facility characteristics (N=1,174 nursing homes) as well as survey procedures, serious mental illness was associated with a 24% reduced odds of having any advance directives (adjusted odds ratio=.76, 95% confidence interval=.66-.87, p<.001). Similar results were found for individual documented plans.Conclusions-Among U.S. nursing home residents, those with serious mental illness were less likely than others to have written medical advance directives. Future research is needed to help understand both resident factors (such as inappropriate behaviors, impaired communication skills, and disrupted family support) and provider factors (including training, experience, and attitude) that underlie this finding.Advance care plans document a person's treatment choices or identify a proxy for health care decisions should the individual become too critically ill to make decisions. Proponents of advance care planning believe that such directives promote patient autonomy, dignity, and comfort in the use of life-sustaining medical treatments. The Patient Self-Determination Act (PSDA) of 1991 requires that health care facilities receiving Medicare or Medicaid reimbursement, including nursing homes, inform their patients of the right to engage in treatment decisions (1). The prevalence of advance directives among nursing home residents, such as do-not-resuscitate (DNR) orders, increased notably after the passage of the act (1-3). However, documentation of advance care plans is found to vary considerably DisclosuresThe authors report no competing interests. It is estimated that between 10% and 25% of U.S. nursing home residents have a serious mental illness, including schizophrenia, bipolar disorder, and other psychosis (6-8). Federal law mandates that persons with serious mental illness should not be admitted to nursing homes unless they show extensive general health care needs that justify institutionalized nursing services above and beyond their mental illness (6,9). Therefore, in additi...

show abstract

End-of-Life Treatment Preferences of Persons With Serious Mental Illness

Cited by 49 publications

References 51 publications

Advance Care Planning in Adults with Cystic Fibrosis

Advance Care Planning in Adults with Cystic Fibrosis

Palliative Care for People with Severe Persistent Mental Illness: A Review of the Literature

Origination of Medical Advance Directives Among Nursing Home Residents With and Without Serious Mental Illness

Contact Info

Product

Resources

About