Patient Preferences for Psychiatric Advance Directives

Abstract

Limited research has examined patients' preferences for psychiatric advance directives (PADs). This study examines the preferences and interest in PADs among patients with severe mental illness. Participants in a randomized controlled trial of PAD facilitation versus usual care were interviewed about their preferences and interest in PADs. Preferences scores were estimated and compared among patients wishing to complete types of PADs. The large majority of participants indicating an interest in a PAD that included a healthcare power of attorney gave greatest importance to enabling surrogate decision making and continuity of care during crises, a minority who expressed interest in a stand-alone advance instruction for mental health treatment or no PAD at all gave highest priority to avoiding unwanted treatment. Persons with severe mental illness have diverse interests in PADs. Most patients give high priority to improving surrogate decision making and continuity of care with PADs.