Advance Directives and the Treatment of Patients with Mental Illness: Can an Advance Directive Avert Court Intervention When the Patient Refuses the Administration of Antipsychotic Medication?

BackgroundAn advance directive is a statement of a person's preferences for treatment, should he or she lose capacity to make treatment decisions in the future.AimsTo evaluate whether use of advance directives by patients with mental illness leads to lower rates of compulsory readmission to hospital.MethodIn a randomised controlled trial in two psychiatric services in inner London, 156 in-patients about to be discharged from compulsory treatment under the Mental Health Act were recruited. The trial compared usual psychiatric care with usual care plus the completion of an advance directive. The primary outcome was the rate of compulsory readmission.ResultsFifteen patients (19%) in the intervention group and 16 (21%) in the control group were readmitted compulsorily within 1 year of discharge. There was no difference in the numbers of compulsory readmissions, numbers of patients readmitted voluntarily, days spent in hospital or satisfaction with psychiatric services.ConclusionsUsers' advance instruction directives had little observable impact on the outcome of care at 12 months.

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A Longitudinal Study of Retirement Transition and Advance Directive Completion

Innovation in Aging ◽

10.1093/geroni/igaa057.1424 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 441-441

Author(s):

Catheryn Koss

Keyword(s):

End Of Life ◽

Advance Directives ◽

Advance Directive ◽

Multinomial Logistic Regression ◽

Statistical Significance ◽

Optimal Time ◽

Retirement Transition ◽

Multistep Process ◽

Study Participants ◽

Retirement Study

Abstract Advance directives (AD) help to ensure patients’ wishes are honored and contribute to improved end-of-life care. According to normative life course theory, retirement is a significant role change that signals a transition into the third age and its socially prescribed activities. To the extent that ACP is viewed as something to do when one reaches a more advanced stage in life, retirement may spark recognition that planning for incapacity and the end of life is now personally relevant and appropriate. This study tested whether transitioning from work to retirement prompted AD completion. The sample included Health and Retirement Study participants 65 and older who, in 2012, had no ADs and were not completely retired (N = 919). Retirement was operationalized as both a categorical status and as a multistep process. Three waves of data were analyzed using multinomial logistic regression to test associations between retirement transition and advance directive completion. By 2014, 21% had completed ADs and another 17% completed them by 2016. Those who completely retired between 2012 and 2014 were almost twice as likely to complete ADs between 2014 and 2016. Graduated increase in level of retirement between 2012 and 2014 was associated with higher odds of new AD possession in 2016, but did not reach statistical significance at p < .05. These results suggest the period following retirement may be an optimal time to encourage patients and clients who have not already done so to complete advance directives.

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Enhancing Competency in Professionalism: Targeting Resident Advance Directive Education

Journal of Graduate Medical Education ◽

10.4300/jgme-d-10-00003.1 ◽

2010 ◽

Vol 2 (2) ◽

pp. 278-282 ◽

Cited By ~ 4

Author(s):

Colleen Y. Colbert ◽

Curtis Mirkes ◽

Paul E. Ogden ◽

Mary Elizabeth Herring ◽

Christian Cable ◽

...

Keyword(s):

Internal Medicine ◽

Medical School ◽

Advance Directives ◽

Advance Directive ◽

Residency Program ◽

Health Science ◽

Science Center ◽

Sufficient Knowledge ◽

Significant Difference ◽

School Curricula

Abstract Background Education about advance directives typically is incorporated into medical school curricula and is not commonly offered in residency. Residents' experiences with advance directives are generally random, nonstandardized, and difficult to assess. In 2008, an advance directive curriculum was developed by the Scott & White/Texas A&M University System Health Science Center College of Medicine (S&W/Texas A&M) internal medicine residency program and the hospital's legal department. A pilot study examining residents' attitudes and experiences regarding advance directives was carried out at 2 medical schools. Methods In 2009, 59 internal medicine and family medicine residents (postgraduate year 2–3 [PGY-2, 3]) completed questionnaires at S&W/Texas A&M (n = 32) and The University of Texas Medical School at Houston (n = 27) during a validation study of knowledge about advance directives. The questionnaire contained Likert-response items assessing attitudes and practices surrounding advance directives. Our analysis included descriptive statistics and analysis of variance (ANOVA) to compare responses across categories. Results While 53% of residents agreed/strongly agreed they had “sufficient knowledge of advance directives, given my years of training,” 47% disagreed/strongly disagreed with that statement. Most (93%) agreed/strongly agreed that “didactic sessions on advance directives should be offered by my hospital, residency program, or medical school.” A test of responses across residency years with ANOVA showed a significant difference between ratings by PGY-2 and PGY-3 residents on 3 items: “Advance directives should only be discussed with patients over 60,” “I have sufficient knowledge of advance directives, given my years of training,” and “I believe my experience with advance directives is adequate for the situations I routinely encounter.” Conclusion Our study highlighted the continuing need for advance directive resident curricula. Medical school curricula alone do not appear to be sufficient for residents' needs in this area.

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End-of-Life Decision-Making in Intensive Care Ten Years after a Law on Advance Directives in Germany

Medicina ◽

10.3390/medicina57090930 ◽

2021 ◽

Vol 57 (9) ◽

pp. 930

Author(s):

Jan A. Graw ◽

Fanny Marsch ◽

Claudia D. Spies ◽

Roland C. E. Francis

Keyword(s):

Decision Making ◽

Intensive Care ◽

End Of Life ◽

Advance Directives ◽

Advance Directive ◽

Medical Center ◽

Relevant Information ◽

Number Of Patients ◽

Before And After ◽

Ethical Approval

Background and Objectives: Mortality on Intensive Care Units (ICUs) is high and death frequently occurs after decisions to limit life-sustaining therapies. An advance directive is a tool meant to preserve patient autonomy by guiding anticipated future treatment decisions once decision-making capacity is lost. Since September 2009, advance directives are legally binding for the caregiver team and the patients’ surrogate decision-maker in Germany. The change in frequencies of end-of-life decisions (EOLDs) and completed advance directives among deceased ICU patients ten years after the enactment of a law on advance directives in Germany is unknown. Materials and Methods: Retrospective analysis on all deceased patients of surgical ICUs of a German university medical center from 08/2008 to 09/2009 and from 01/2019 to 09/2019. Frequency of EOLDs and advance directives and the process of EOLDs were compared between patients admitted before and after the change in legislation. (No. of ethical approval EA2/308/20) Results: Significantly more EOLDs occurred in the 2019 cohort compared to the 2009 cohort (85.8% vs. 70.7% of deceased patients, p = 0.006). The number of patients possessing an advance directive to express a living or therapeutic will was higher in the 2019 cohort compared to the 2009 cohort (26.4% vs. 8.9%; difference: 17.5%, p < 0.001). Participation of the patients’ family in the EOLD process (74.7% vs. 60.9%; difference: 13.8%, p = 0.048) and the frequency of documentation of EOLD-relevant information (50.0% vs. 18.7%; difference: 31.3%, p < 0.001) increased from 2009 to 2019. Discussion: During a ten-year period from 2009 to 2019, the frequency of EOLDs and the completion rate of advance directives have increased considerably. In addition, EOLD-associated communication and documentation have further improved.

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Review of smoking cessation treatments for people with mental illness

Advances in Psychiatric Treatment ◽

10.1192/apt.bp.107.003483 ◽

2008 ◽

Vol 14 (3) ◽

pp. 208-216 ◽

Cited By ~ 27

Author(s):

Jonathan Campion ◽

Ken Checinski ◽

Jo Nurse

Keyword(s):

Mental Health ◽

Mental Illness ◽

Smoking Cessation ◽

General Population ◽

Antipsychotic Medication ◽

Gold Standard ◽

Standard Treatment ◽

Mental Health Problems ◽

Quit Smoking ◽

People With Mental Illness

This article reviews the current literature regarding treatments for smoking cessation in both the general population and in those with mental health problems. The gold-standard treatment for the general population is pharmacotherapy (nicotine replacement therapy, bupropion or varenicline) coupled with individual or group psychological support. This is also effective in helping people with mental illness to reduce or quit smoking, but care must be taken to avoid adverse medication interactions and to monitor antipsychotic medication in particular as cigarette consumption reduces.

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Advance Directives, Do Not Resuscitate Orders, and Power of Attorney for Health Care

10.2310/obg.2187 ◽

2018 ◽

Author(s):

Laura Stafman ◽

Sushanth Reddy

Keyword(s):

Health Care ◽

Decision Making ◽

Advance Directives ◽

Advance Directive ◽

Persistent Vegetative State ◽

Living Will ◽

Do Not Resuscitate ◽

Power Of Attorney ◽

Decision Making Capacity ◽

Do Not Resuscitate Orders

In 2005, Terri Schiavo collapsed at home and was found by her husband without respirations or a pulse. She was resuscitated, but suffered severe anoxic brain injury and after 21/2 months was diagnosed as being in a persistent vegetative state. A court appointed her husband as her legal guardian as she did not have a written advance directive and had not specified a power of attorney for health care (POAHC), but heated court battles raged between her husband and her parents regarding who should be making decisions and what the appropriate decisions were. This case highlights the importance of writing down instructions for end-of-life care or designating someone to make decisions in their best interest in the event they could not make these decisions themselves. This review covers advance directives, do-not-resuscitate orders, and POAHC. Figures show an extended values history form, an example of a living will, the California’s Physician Orders for Life-Sustaining Treatment form, components of the CURVES mnemonic to assess decision-making capacity in critical/emergency situations, and activation and deactivation of power of attorney for health care. Tables list the most common types of advance directive and description of each, barriers to the use of advance directives, common themes in surgeons’ attitudes regarding advance directives, general requirements and exclusions for POAHC, and requirements for decision-making capacity in patients. This review contains 5 highly rendered figures, 5 tables, and 56 references

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A preliminary investigation of opinions and behaviors regarding advance directives for medical care

American Journal of Critical Care ◽

10.4037/ajcc1993.2.2.161 ◽

1993 ◽

Vol 2 (2) ◽

pp. 161-167 ◽

Cited By ~ 37

Author(s):

EH Elpern ◽

SB Yellen ◽

LA Burton

Keyword(s):

Advance Directives ◽

Advance Directive ◽

Medical Center ◽

Academic Medical Center ◽

Preliminary Investigation ◽

Tertiary Care ◽

Living Will ◽

Treatment Preferences ◽

Convenience Sample ◽

And Behaviors

BACKGROUND: Advance directives are a means of promoting patient autonomy in end-of-life decisions but are used infrequently. A recent federal law requires healthcare organizations to provide information to patients about advance directives. This study explored attitudes and behaviors related to the use of advance directives in three areas: familiarity with advance directives, reasons for completing or not completing advance directives and preferences for receiving information about advance directives. METHODS: A questionnaire was administered by personal interview to a nonrandomized convenience sample of 46 inpatients and 50 outpatients at a large, tertiary care, urban academic medical center in the summer of 1991. RESULTS: Most respondents (77%) had heard of either the living will or durable power of attorney for healthcare, but only 52% correctly understood the purpose of these documents. Twenty-nine percent of the sample had executed an advance directive. Those who had advance directives were older and considered themselves less healthy than did those without advance directives. Unfamiliarity with advance directives and procrastination were cited most often as reasons for not having an advance directive. Most subjects (65%) had spoken with someone, usually a family member or close friend, about preferences for treatment during a critical illness. Although they had rarely discussed advance directives, 83% anticipated that they would be comfortable doing so with a physician or a nurse. CONCLUSIONS: Advance directives are used infrequently to document treatment preferences. The success of programs to promote greater use of advance directives depends on a clearer understanding of the factors that influence both decision and action to execute an advance directive. Patients claim to be comfortable in discussing the topic and prefer that such discussions occur in the outpatient setting.

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High risk of metabolic syndrome among black South African women with severe mental illness

South African Journal of Psychiatry ◽

10.4102/sajpsychiatry.v23i0.1089 ◽

2017 ◽

Vol 23 ◽

Author(s):

Shamima Saloojee ◽

Jonathan K. Burns ◽

Ayesha A. Motala

Keyword(s):

Metabolic Syndrome ◽

Mental Illness ◽

Severe Mental Illness ◽

South African ◽

Antipsychotic Medication ◽

Matched Control ◽

Control Group ◽

Men And Women ◽

Matched Control Group ◽

Black South African

Background: There is an increased prevalence of metabolic syndrome (MetS) in individuals with severe mental illness (SMI) globally. The prevalence of MetS is higher in black women compared to black men from South Africa.Aim: To compare the prevalence of MetS between black South African men and women with SMI taking antipsychotic medication. Further, this prevalence was compared to the prevalence in a matched control group of black South African men and women without SMI. Setting: A general hospital psychiatric unit.Methods: A cross-sectional study was undertaken to compare the prevalence of MetS in a group of multi-ethnic participants with SMI treated with antipsychotic medication and a matched control group without SMI, applying the 2009 Joint Interim Statement (JIS) criteria. Here, we included only the black African participants to compare MetS prevalence between men and women.Results: There were 232 participants in the group with SMI (male 155 and female 77) and without SMI (male 156 and female 76). The prevalence of MetS was more than three times higher in women with SMI compared to men with SMI (37.7% vs. 10.3%, p < 0.001). There was no significant difference in the prevalence of MetS in men or women between the groups with and without SMI. In multivariate logistic regression analysis, female gender (odds ratio [OR] 7.66), advancing age (OR 1.08) and longer duration of illness (OR = 1.15) were significant risk factors for MetS in SMI.Conclusion: In black South Africans with SMI on antipsychotic medication, there is a higher prevalence and risk for MetS in women compared to men.

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