Medical Advance Care Planning for Persons With Serious Mental Illness

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

doi:10.1176/appi.ps.56.5.576

Cited by 51 publications

(91 citation statements)

References 57 publications

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“…The most common concerns were: financial burden on family or loved ones; emotional burden on loved ones; being in pain and suffering; interpersonal issues such as leaving family and friends; funeral and disposition of the person's body; and spiritual concerns. 5 Most participants believed that someone should be designated to make health care decisions for a person who is too sick to do so. 5 Foti's research also supports the "feasibility, acceptability and utility of a standardized approach to medical advanced care planning."…”

Section: Resultsmentioning

confidence: 99%

“…5 Most participants believed that someone should be designated to make health care decisions for a person who is too sick to do so. 5 Foti's research also supports the "feasibility, acceptability and utility of a standardized approach to medical advanced care planning." 5 While there are potential benefits to advance directives, such as supporting autonomy and enhancing communication, and while many jurisdictions have advance care legislation and guidelines in place with court-ordered precedent for them to be respected, 29 there may be institutional or legal impediments to advance care planning for people with SPMI.…”

Section: Resultsmentioning

confidence: 99%

“…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%

“…Foti actively sought input from people with SPMI regarding health preferences, selection of a health care proxy, and advance care planning for end-of-life illnesses. 5,27 As a result, their perspective is represented more directly than elsewhere.…”

Section: Strengths and Limitations Of The Papersmentioning

confidence: 99%

See 3 more Smart Citations

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

Woods

Willison²,

Kington³

et al. 2008

Can J Psychiatry

136

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Provision Of Carementioning

confidence: 99%

Section: Strengths and Limitations Of The Papersmentioning

confidence: 99%

See 2 more Smart Citations

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

show abstract

“…In 1995, a report from the U.S. Government noted that 10 to 25% of Americans had an AMD (U.S. Government Accountability Office, 1995). Later studies have reported AMD documentation in less than 20% of the U.S. general public (DeLuca, 2000), 19% of patients with cancer (Dy et al, 2010), 26% of medical-surgical inpatients (Salmond & David, 2005), 18% of mentally ill persons (Foti, Bartels, Merriman, Fletcher, & Van Citters, 2005), 70% of community-dwelling older adults (Teno, Gruneir, Schwartz, Nanda, & Wetle, 2007), and 35% of nursing home residents (Bradley, Wetle, & Horwitz, 1998).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Advance Medical Directive Inquiry and Documentation for Hospital Inpatients in Three Medical Services: Implications for Policy Changes

Anunobi

Detweiler

Sethi

et al. 2015

Journal of Aging & Social Policy

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Following the introduction of the Patient Self-Determination Act of 1990, the Veterans Health Administration developed its own advance medical directive (AMD) policy, which most recently states that documentation is mandatory for all hospital patients in all settings. The object of this study was to assess the effectiveness of AMD documentation at a local Veterans Affairs Medical Center. AMD documentation was compared among three inpatient services: surgery, medicine, and psychiatry. Retrospective in nature, 594 inpatient cases were compared. Results revealed that, overall, the rate of AMD documentation was 37.7%. AMD documentation on surgery was statistically more frequent (45.6%) than for either medicine (33.2%) or psychiatry (34.5%). The difference between the numbers of days to AMD documentation for all three services was not statistically significant. While there was no statistically significant difference across gender, Caucasians had AMDs documented more frequently than African Americans (p < .001). Logistic regression reveals that social worker and physician intervention, not patient-specific variables, are the primary predictors of AMD incidence. Policy makers may need to consider the realities of hospital care, especially in emergency settings, and be more specific in the steps of implementation of the policy in the evenings, weekends, and holidays. True adherence to policy implementation may require hospital administrators to increase staff and educational efforts so that the concept of AMD communication and documentation is completely explained to all staff and patients. Policy should include an electronic record reminder that is renewed every 3 years and provisions for accommodating patients who arrive on weekends and holidays, with special awareness of the particular communication needs of minority groups. The study conclusions are that further inquiry is needed to understand these policy nuances to enable the Veterans Affairs Administration to improve its policies and performance in this important aspect of healthcare.

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Disparities in Preoperative Goals of Care Documentation in Veterans

Wu,

Giannitrapani,

Garcia

et al. 2023

JAMA Netw Open

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ImportancePreoperative goals of care discussion and documentation are important for patients undergoing surgery, a major health care stressor that incurs risk.ObjectiveTo assess the association of race, ethnicity, and other factors, including history of mental health disability, with disparities in preoperative goals of care documentation among veterans.Design, Setting, and ParticipantsThis retrospective cross-sectional study assessed data from the Veterans Healthcare Administration (VHA) of 229 737 veterans who underwent surgical procedures between January 1, 2017, and October 18, 2022.ExposuresPatient-level (ie, race, ethnicity, medical comorbidities, history of mental health comorbidity) and system-level (ie, facility complexity level) factors.Main Outcomes and MeasuresPreoperative life-sustaining treatment (LST) note documentation or no LST note documentation within 30 days prior to or on day of surgery. The standardized mean differences were calculated to assess the magnitude of differences between groups. Odds ratios (ORs) and 95% CIs were estimated with logistic regression.ResultsIn this study, 13 408 patients (5.8%) completed preoperative LST from 229 737 VHA patients (209 123 [91.0%] male; 20 614 [9.0%] female; mean [SD] age, 65.5 [11.9] years) who received surgery. Compared with patients who did complete preoperative LST, patients tended to complete preoperative documentation less often if they were female (19 914 [9.2%] vs 700 [5.2%]), Black individuals (42 571 [19.7%] vs 2416 [18.0%]), Hispanic individuals (11 793 [5.5%] vs 631 [4.7%]), or from rural areas (75 637 [35.0%] vs 4273 [31.9%]); had a history of mental health disability (65 974 [30.5%] vs 4053 [30.2%]); or were seen at lowest-complexity (ie, level 3) facilities (7849 [3.6%] vs 78 [0.6%]). Over time, despite the COVID-19 pandemic, patients undergoing surgical procedures completed preoperative LST increasingly more often. Covariate-adjusted estimates of preoperative LST completion demonstrated that patients of racial or ethnic minority background (Black patients: OR, 0.79; 95% CI, 0.77-0.80; P &lt;.001; patients selecting other race: OR, 0.78; 95% CI, 0.74-0.81; P &lt;.001; Hispanic patients: OR, 0.78; 95% CI, 0.76-0.81; P &lt;.001) and patients from rural regions (OR, 0.91; 95% CI, 0.90-0.93; P &lt;.001) had lower likelihoods of completing LST compared with patients who were White or non-Hispanic and patients from urban areas. Patients with any mental health disability history also had lower likelihood of completing preoperative LST than those without a history (OR, 0.93; 95% CI, 0.92-0.94; P = .001).Conclusions and RelevanceIn this cross-sectional study, disparities in documentation rates within a VHA cohort persisted based on race, ethnicity, rurality of patient residence, history of mental health disability, and access to high-volume, high-complexity facilities.

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Medical Advance Care Planning for Persons With Serious Mental Illness

Cited by 51 publications

References 57 publications

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

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

Comparison of Advance Medical Directive Inquiry and Documentation for Hospital Inpatients in Three Medical Services: Implications for Policy Changes

Disparities in Preoperative Goals of Care Documentation in Veterans

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