Using a Hypothetical Scenario to Inform Psychiatric Advance Directives

• Published in: Psychiatric services (Washington, D.C.) Vol. 58; no. 11; pp. 1467 - 1471
• Main Authors: Van Citters, Aricca D, Naidoo, Umadevi, Foti, Mary Ellen
• Format: Journal Article
• Language: English
• Published: Washington, DC American Psychiatric Association 01-11-2007; American Psychiatric Publishing, Inc
• Subjects: Adult; Advance directives; Advance Directives - psychology; Biological and medical sciences; Data collection; Decision Making; Educational materials; Electroconvulsive therapy; Female; Health facilities; Health services; Humans; Informed consent; Judicial reviews; Male; Massachusetts; Medical sciences; Mental Disorders - therapy; Mental health care; Middle Aged; Miscellaneous; Palliative care; Patient Participation - methods; Personality disorders; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Public health. Hygiene; Public health. Hygiene-occupational medicine; Social psychiatry. Ethnopsychiatry; Surveys and Questionnaires; Massachusetts; Advance directives; End of life decision; Psychiatry; Public health; Mental health
• ISSN: 1075-2730; 1557-9700
• DOI: 10.1176/ps.2007.58.11.1467

The study addressed whether a hypothetical psychiatric scenario is a feasible approach for eliciting psychiatric treatment preferences and identified consumer preferences regarding involuntary care.
Community-residing adults with serious mental illness (N=150) voluntarily completed the Health Care Preferences Questionnaire to determine treatment preferences in response to the use of psychiatric medications, seclusion and restraint, and electroconvulsive therapy (ECT). A vignette was used to determine preferences first with respect to an imaginary patient and then with respect to the respondent.
Few participants were distressed by the psychiatric scenario (7%). In regard to their own care, in an emergency most participants supported the use of involuntary treatments (medications, 70%; medication injection, 76%; and seclusion and restraint, 73%), with the exception of ECT (quick treatment, 32%; if life is in danger, 60%). Participants were less likely to support treatments for themselves than for an imaginary patient. The majority (65%) identified specific medication preferences.
Scenarios about the state of medical and psychiatric health are a feasible method of identifying treatment preferences. They are well tolerated and may serve as a model for assisting persons with serious mental illness in considering difficult treatment decisions.