What do service users want? A content analysis of what users may write in psychiatric advance directives in India

Factors influencing advance directives among psychiatric inpatients in India

“…Our results were similar to the SCARF Study from south India (Kumar et al, 2013), and the study by Pathare (2015) where most patients wrote a PAD. In our study, the socio- Our study showed that treatment preferences in PADs are not influenced by any individual socio-demographic variables, such as gender, educational level, or social class.…”

“…Recently, Pathare investigated service users and their families' opinions about the new legislation. In that study, most users agreed to formulate a PAD and were comfortable in appointing a nominated representative(Pathare et al, 2015). Contrary to studies in high-income countries, patients almost all adhered to treatment suggestions made by doctors.…”

Psychiatric Advance Directives in India: What will the future hold?

“…The majority (n = 37) did not even demand any particular choice of medication and expressed confidence in their doctor's advice. Predictably, ECT use remained a contentious area-a slender majority of patients (39 v/s 30) were unwilling to consider it at all (Pathare et al, 2015). A second study evaluated 92 completed model PADs of patients at SCARF, Chennai (Kumar et al, 2013).…”

“…Even in countries where PADs are already in force, clinicians consistently report uneasiness about ensuing legal liability, resource/logistics shortfalls and interference with clinical aspects of care (Shields et al, 2014)-treating psychiatric patients within the framework of their pre-stated wishes is clearly a much more (2015) xxx-xxx intricate and arduous task than doing so in India's prevailing 'doctor-patient hierarchy' zeitgeist (Kala, 2013;Pathare et al, 2015). Accepting this challenge is an opportunity for Psychiatry to counter allegations of autocracy and impunity its most vocal critics level.…”

Psychiatric Advance Directives and their relevance to improving psychiatric care in Asian countries

“…Principles of beneficence often drive the dynamics of healthcare provisions in Asia. This may lead service users to defer medical decisions to their doctor (Pathare, Shields, Nardodkar, Narasimhan, & Bunders, ; Poremski et al, ). Efforts to introduce advance psychiatric directives may therefore be impeded by low uptake, as in the case of medical directives (Tay et al, ).…”