Effectively Implementing Psychiatric Advance Directives

超出提供的空间。精神病学预先指令(PAD)允许有能力的人在精神健康危机之前宣布他们的治疗偏好，并指定一名代理决策者，当他们可能失去做出可靠医疗决定的能力时。15个州已经通过了PAD立法，但几乎没有进行过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港口及机场发展策略的有效运作？PAD是否符合临床对适当治疗的判断？在实践环境中如何实际使用和执行PAD？具有某些特征的PAD是否提高了治疗参与度，改善了围绕精神危机的护理过程，并为严重精神疾病(SMI)患者提供了更大的自主感？如果在没有充分的理解或说明的情况下编制，或者如果没有按计划实施，港口和机场发展策略是否会产生负面影响？这项拟议的研究将解决以下问题：(1)进行促进精神病学先行指令(F-PAD)的随机试验，这是一种手册化的、经过试点测试的干预措施，以帮助消费者完成PAD；(2)在北卡罗来纳州N=400名患有SMI的消费者中，检查PADS的实施情况(超过1年)。受试者将被随机分配到F-Pad干预组或“常规护理”对照组。如果F-PAD受试者愿意，他们将在填写模板结构的PAD和医疗委托书(HCPA)文档时获得个性化的指导和帮助。对照受试者将获得关于港口及机场发展策略的简要介绍(作为对研究的知情同意的一部分)、书面材料、参加有关港口及机场发展策略的团体教育会议的机会，以及提供有关港口及机场发展策略咨询的消费者组织的电话号码。临床医生和代理人也将被给予关于PADS的指导。受试者和他们的临床医生将在1个月和12个月时接受结构化访谈，以检查PADS/HCPA的完成率、其结构和内容、随后的治疗参与和危机处理结果。PAD/HCPA文件将以电子方式存储在美国生前遗嘱登记处，该登记处提供对高级护理文件的自动访问。这项拟议的研究将提供一个州在港口及机场发展策略方面的经验，以便指导政策制定者在其他地方实施港口及机场发展策略。表演网站========================================Section End===========================================

EXCEED THE SPACE PROVIDED. Psychiatric advance directives (PADs) allow competent persons to declare their treatment preferences and designate a proxy decisionmaker 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 F- PAD 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 policy- makers may be guided in implementing PADs elsewhere. PERFORMANCE SITE ========================================Section End===========================================