Effectively Implementing Psychiatric Advance Directives

有效实施精神病学预先指示

• 批准号: 6580721
• 负责人: JEFFREY W SWANSON
• 金额: $ 53.91万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-12-01 至 2006-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6580721
• 关键词: behavioral /social science research tag; choice; clinical research; counseling; decision making; health care policy; health related legal; human subject; informed consent; interview; longitudinal human study; mental health education; patient /disease registry; psychiatry

DESCRIPTION (provided by applicant): Psychiatric advance directives (PADs) allow competent persons to declare their treatment preferences and designate a proxy decision maker in advance of a mental health crisis when they may lose capacity to make reliable healthcare decisions. Fifteen states have adopted PAD legislation, yet little research has been conducted to answer emerging policy questions: What is the demand for PADs among consumers? Is formal assistance necessary to facilitate effective PADs? Do PADs conform with clinical judgments of appropriate treatment? How are PADs actually used and enforced in practice settings? Do PADs with certain features enhance treatment engagement, improve the process of care surrounding psychiatric crises, and provide a greater sense of autonomy for persons with severe mental illness (SMI)? Might PADs have negative consequences, e.g., if prepared without adequate comprehension or instructions, or if not implemented as planned? The proposed study will address these questions as follows: (1) Conduct a randomized trial of Facilitated Psychiatric Advance Directives (F-PAD), a manualized, pilot-tested intervention to assist consumers in completing PADs; (2) Examine the implementation of PADs over 1 year) in a sample of N=400 consumers with SMI in North Carolina. Subjects will be randomly assigned to the FPAD intervention or a "usual care" control group. F-PAD subjects will be given individualized orientation and assistance in completing a template-structured PAD and healthcare power of attorney (HCPA) document if they wish. Control subjects will receive a brief orientation to PADs (as part of informed consent to the study), written material, an opportunity to attend a group education meeting about PADs, and the telephone number of a consumer organization that provides consultation regarding PADs. Clinicians and proxies will also be given orientation regarding PADs. Subjects and their clinicians will be followed up with a structured interview at 1 month and 12 months to examine the rate of completion of PADs/HCPA, their structure and content, subsequent treatment engagement and crisis management outcomes. PAD/HCPA documents will be electronically stored with the U.S. Living Will Registry, which provides automated access to advance care documents. The proposed study will provide information about a state's experience with PADs so that policymakers may be guided in implementing PADs elsewhere.

描述（由申请人提供）：精神病学预先指示 (PAD) 允许有能力的人员在精神健康危机发生之前（当他们可能失去做出可靠医疗保健决策的能力时）声明他们的治疗偏好并指定代理决策者。 已有 15 个州通过了 PAD 立法，但很少有研究来回答新出现的政策问题：消费者对 PAD 的需求是什么？ 是否需要正式援助来促进有效的 PAD？ PAD 是否符合适当治疗的临床判断？ PAD 在实践中是如何实际使用和执行的？ 具有某些功能的 PAD 是否可以提高治疗参与度、改善精神危机护理流程并为严重精神疾病 (SMI) 患者提供更大的自主感？ PAD 是否会产生负面后果，例如，如果在没有充分理解或指导的情况下进行准备，或者没有按计划实施？ 拟议的研究将解决这些问题如下：(1) 对简易精神病学预先指示 (F-PAD) 进行随机试验，这是一种手动的、经过试点测试的干预措施，旨在帮助消费者完成 PAD； (2) 以北卡罗来纳州 N=400 名患有 SMI 的消费者为样本，检查 PAD 的实施情况（超过 1 年）。受试者将被随机分配到 FPAD 干预组或“常规护理”对照组。 如果 F-PAD 受试者愿意，将获得个性化的指导和帮助，以完成模板结构的 PAD 和医疗保健授权书 (HCPA) 文件。 对照受试者将收到有关 PAD 的简要介绍（作为研究知情同意的一部分）、书面材料、参加有关 PAD 的团体教育会议的机会以及提供有关 PAD 咨询的消费者组织的电话号码。临床医生和代理人也将获得有关 PAD 的指导。 受试者及其临床医生将在 1 个月和 12 个月时进行结构化访谈，以检查 PAD/HCPA 的完成率、其结构和内容、后续治疗参与度和危机管理结果。 PAD/HCPA 文件将以电子方式存储在美国生前遗嘱登记处，该登记处提供对预先护理文件的自动访问。 拟议的研究将提供有关国家在 PAD 方面的经验的信息，以便政策制定者可以在其他地方实施 PAD 时得到指导。