How Should we Implement Psychiatric Advance Directives? Views of Consumers, Caregivers, Mental Health Providers and Researchers
- 463 Downloads
The aim of this study was to measure expert consensus on the implementation of Psychiatric Advance Directives (PADs) within the Veterans Health Administration. We conducted a two-round Delphi study with 55 panelists including consumers, caregivers, mental health providers and researchers. For a number of items where no positive or negative consensus was reached we found differences between the views of consumers and non-consumers, reflecting consumer’s preferences for nonmedical settings for completion and assistance with completion independent of the treatment team. Thus, the principle of consumer choice that applies to MHAD content should also be applied to the process of completion offered.
KeywordsPsychiatric advance directives Consensus study Implementation
We wish to thank Andrea Jamison, PhD, James J Peters VA Medical Center; Antonette Zeiss, PhD, VA Central Office; Robert A. Pearlman, MD, MPH, Chief, Ethics Evaluation, National Center for Ethics in Health Care (VHA) and Ruth Cecire, PhD, Policy Analyst, National Center for Ethics in Health Care for providing the draft worksheets and information on the plans for implementation of the VA MHAD; Daniel Herman, PhD, and Helen Rasmussen, M.S.W., for comments on drafts of the questionnaire. Michaela Amering, Patricia Backlar, Toni Beard, Tom Berger, Daniel Bradford, Loretta Braxton, Roy Brown, Jennifer Bucci, William Crandell, Deb Define, Dianna Dragatsi, Eric Elbogen, Ann Feder, Chris Flood, Mary Ellen Foti, Bert Harvey, John Hendershot, Peggy Henderson, Scott Hicks, Shirley Holland, Teresa Isner, Thomas Kallert, Miriam Keith, Mimi Kim, Lona King, Doreen Krodel, Rufina Lee, Stephanie LeMelle, Miklos Losonczy, David Lowenthal, James McDonagh, Hunter McQuistion, Susan Mirch-Kertschmann, Mary Nettle, Maria O’Connell, consumer advocate (name withheld), Melody Riefer, Diana Rose, Jana Spalding, Kim Sutherby, Jeffrey Swanson, Marvin Swartz, George Szmukler, John Tatarakis, Gaila Taylor, Crescent Terry, Graham Thornicroft, Richard van Dorn, Colleen Vaughan, Kendra Weaver, Jacqueline Woo, Carol Youtz, Laura Ziegler, Martin Zinkler. The views expressed in this article are those of the authors and do not necessarily reflect the positions or policies of affiliated institutions. This study was supported by the Department of Veterans Affairs Health Services Research and Development Service # SHP-08-163 and by a Department of Veterans Affairs Research Career Development Award to the last author #RCD-06-020. James J. Peters in VA Medical Center at that time the study was conducted.
- VHA Handbook 1004.2, “Advance Care Planning and Management of Advance Directives”. http://vaww1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1542.
- Leslie, D. L., & Rosenheck, R. (2006). Eighth annual report on Schizophrenia Pharmacotherapy in VA. West Haven, CT: VA Connecticut MIRECC and NEPEC.Google Scholar
- Murphy, M. K., Black, N., Lamping, D. L., McKee, C. M., Sanderson, C. F. B., Askham, J., et al. (1998). Consensus development methods and their use in clinical guideline development. Health Technology Assessment, 2, 3.Google Scholar
- National Ethics Committee of the Veterans Health Administration. (2008). Advance directives for mental health: An ethical analysis of state laws & implications for VHA policy. Washington, DC, National Center for Ethics in Health Care, Veterans Health Administration. Department of Veterans Affairs.Google Scholar
- Proctor, E. K., Landsverk, J., Aarons, G., Chambers, D., Glisson, C., & Mittman, B. (2009). Implementation research in mental health services: An emerging science with conceptual, methodological, and training challenges. Administration and Policy in Mental Health and Mental Health Services Research, 36, 24–34.CrossRefPubMedGoogle Scholar
- Strauss, J. L., O’Loughlin, S. H., Keng, S., Stechuchak, K. M., Olsen, M. K., & Zervakis, J. B., et al. (2007). Content analysis of psychiatric advance directives: treatment preferences expressed by veterans with severe mental illness. Poster presented at the Annual HSR & D Career Development Conference. Arlington, VA.Google Scholar
- Strauss, J. L., Stechuchak, K. M., & Olsen, M. K., et al. (2008). Results from a randomized controlled trial to facilitate the use of psychiatric advance directives: lessons learned. Abstract presented at the 26th annual health services research and development meeting. Baltimore, MD.Google Scholar
- Swanson, J. W., Swartz, M. S., Hannon, M. J., et al. (2003). Psychiatric advance directives: a survey of persons with schizophrenia, family members, and treatment providers. International Journal of Forensic Mental Health, 2, 73–86.Google Scholar
- US Department of Veterans Affairs. (2004). VHA Comprehensive Mental Health Strategic Plan.Google Scholar