title: Competence to complete psychiatric advance directives: effects of facilitated decision making.
abstract: Psychiatric advance directives (PADs) statutes presume competence to complete these documents, but the range and dimensions of decisional competence among people who actually complete PADs is unknown. This study examines clinical and neuropsychological correlates of performance on a measure to assess competence to complete PADs and investigates the effects of a facilitated PAD intervention on decisional capacity. N=469 adults with psychotic disorders were interviewed at baseline and then randomly assigned to either a control group in which they received written materials about PADs or to an intervention group in which they were offered an opportunity to meet individually with a trained facilitator to create a PAD. At baseline, domains on the Decisional Competence Assessment Tool for PADs (DCAT-PAD) were most strongly associated with IQ, verbal memory, abstract thinking, and psychiatric symptoms. At one-month follow-up, participants in the intervention group showed more improvement on the DCAT-PAD than controls, particularly among participants with pre-morbid IQ estimates below the median of 100. The results suggest that PAD facilitation is an effective method to boost competence of cognitively-impaired clients to write PADs and make treatment decisions within PADs, thereby maximizing the chances their advance directives will be valid.
authors.affiliation: Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Brightleaf Square Suite 23-A, 905 West Main Street, DUMC Box 3071, Durham, NC 27710, USA. eric.elbogen@duke.edu
authors.forename: Eric B
authors.initials: EB
authors.lastname: Elbogen
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Swanson
authors.forename: Paul S
authors.initials: PS
authors.lastname: Appelbaum
authors.forename: Marvin S
authors.initials: MS
authors.lastname: Swartz
authors.forename: Joelle
authors.initials: J
authors.lastname: Ferron
authors.forename: Richard A
authors.initials: RA
authors.lastname: Van Dorn
authors.forename: H Ryan
authors.initials: HR
authors.lastname: Wagner
mesh_terms: D000328:Adult; D016223:Advance Directives; D003376:Counseling; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D016743:Mental Competency; D015999:Multivariate Analysis; D009657:North Carolina; D011618:Psychotic Disorders / Q000523:psychology