Medical Advance Care Planning for Persons With Serious Mental Illness

• Published in: Psychiatric services (Washington, D.C.) Vol. 56; no. 5; pp. 576 - 584
• Main Authors: Foti, Mary Ellen, Bartels, Stephen J, Merriman, Melanie P, Fletcher, Kenneth E, Van Citters, Aricca D
• Format: Journal Article
• Language: English
• Published: Washington, DC American Psychiatric Publishing 01-05-2005; American Psychiatric Association; American Psychiatric Publishing, Inc
• Subjects: Acute Disease; Adult; Advance Care Planning; Bioethics; Biological and medical sciences; Ethics; Female; Humans; Male; Massachusetts; Medical sciences; Mental Disorders - therapy; Middle Aged; Patient Satisfaction - statistics & numerical data; Proxy; Surveys and Questionnaires; Terminal Care; Massachusetts; Belief; Human; Psychology; Mental health; End of life decision; Advance directives; Care; Medicine; Ethics; Mental disorder; Severe; Psychiatry; Public health; Empirical Approach; Death and Euthanasia
• ISSN: 1075-2730; 1557-9700
• DOI: 10.1176/appi.ps.56.5.576

OBJECTIVE: This study examined preferences regarding medical advance care planning among persons with serious mental illness, specifically, experience, beliefs, values, and concerns about health care proxies and end-of-life issues. METHODS: A structured interview, the Health Care Preferences Questionnaire, was administered to a convenience sample of 150 adults with serious mental illness who were receiving community-based services from the Massachusetts Department of Mental Health. Clinical information and demographic data were also collected. RESULTS: A total of 142 participants completed the questionnaire. Although more than one-quarter had thought about their medical treatment preferences in the event that they became seriously medically ill, very few had discussed these preferences. A majority of respondents (72 percent) believed that someone should be designated to make medical health care decisions for a person who is too sick to make or communicate these decisions him- or herself. Common end-of-life concerns included financial and emotional burdens on family, pain and suffering, interpersonal issues such as saying "goodbye," spiritual issues, and funeral arrangements. Participants were most uneasy about the prolonging or stopping of life support by proxy decision makers. A total of 104 respondents (69 percent) expressed interest in formally selecting a health care proxy. CONCLUSIONS: Although persons with serious and persistent mental illness have little experience with medical advance care planning, they show substantial interest in it. Furthermore, they are able to consider and communicate their preferences. This study supports the feasibility, acceptability, and utility of a standardized approach to medical advance care planning with this population.