Citation

Easter MM, Swanson JW, Robertson AG, Moser LL, Swartz MS. Psychiatr. Serv. 2017; 68(7): 717-723.

Affiliation

Dr. Easter, Dr. Swanson, Dr. Robertson, and Dr. Swartz are with the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina. Dr. Moser is with the Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina.

Copyright

(Copyright © 2017, American Psychiatric Association)

DOI

10.1176/appi.ps.201600423

PMID

28366114

Abstract

OBJECTIVE: Psychiatric advance directives (PADs) provide a legal mechanism for competent adults to document care preferences and authorize a surrogate to make treatment decisions. In a controlled research setting, an evidence-based intervention, the facilitated psychiatric advance directive (FPAD), was previously shown to overcome most barriers to PAD completion. This study examined implementation of the FPAD intervention in usual care settings as delivered by peer support specialists and nonpeer clinicians on assertive community treatment (ACT) teams.

METHODS: A total of 145 ACT consumers were randomly assigned, within teams, to FPAD with facilitation by either a peer (N=71) or a clinician (N=74). Completion rates and PAD quality were compared with the previous study's standard and across facilitator type. Logistic regression was used to estimate effects on the likelihood of PAD completion.

RESULTS: The completion rate of 50% in the intent-to-treat sample (N=145) was somewhat inferior to the prior standard (61%), but the rate of 58% for the retained sample (those who completed a follow-up interview, N=116) was not significantly different from the standard. Rates for peers and clinicians did not differ significantly from each other for either sample. PAD quality was similar to that achieved in the prior study. Four consumer variables predicted completion: independent living status, problematic substance use, length of time served by the ACT team, and no perceived unmet need for hospitalization in crisis.

CONCLUSIONS: Peers and clinicians can play a crucial role in increasing the number of consumers with PADs, an important step toward improving implementation of PADs in mental health care.

Language: en

Keywords

Advance directives/proxies; Assertive community treatment; Community mental health services; Recovery; Staff relationships/roles