title: Effect of patients' reasons for refusing treatment on implementing psychiatric advance directives.
abstract: OBJECTIVE
  Clinicians have raised concerns that psychiatric advance directives may be used to refuse all treatment. However, people writing psychiatric advance directives can explicitly state their reasoning underlying treatment decisions. This study examined whether patients' reasons for refusing treatment influenced clinician decision making about implementing psychiatric advance directives.
  
  
  METHODS
  A total of 597 mental health professionals completed a questionnaire that presented two scenarios: one in which the patient wrote a psychiatric advance directive refusing all medication because of paranoid delusions and one in which the patient wrote a psychiatric advance directive refusing all medication because of concerns about side effects.
  
  
  RESULTS
  Twenty-two percent of clinicians reported that they would respect the former psychiatric advance directive, whereas 72% reported that they would respect the latter. After multivariate regression was used, the reason for treatment refusal remained the single significant predictor of clinicians' decision to honor a patient's psychiatric advance directive.
  
  
  CONCLUSIONS
  Results show reasons for treatment refusal in psychiatric advance directives are likely to affect clinicians' decisions to implement the directives.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3837, Durham, NC 27710, USA. christine.wilder@duke.edu
authors.forename: Christine M
authors.initials: CM
authors.lastname: Wilder
authors.forename: Eric B
authors.initials: EB
authors.lastname: Elbogen
authors.forename: Marvin S
authors.initials: MS
authors.lastname: Swartz
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Swanson
authors.forename: Richard A
authors.initials: RA
authors.lastname: Van Dorn
mesh_terms: D000328:Adult; D016223:Advance Directives / Q000523:psychology*; D001291:Attitude of Health Personnel; D006801:Humans; D008875:Middle Aged; D009657:North Carolina; D010361:Patients / Q000523:psychology*; D011795:Surveys and Questionnaires; D016312:Treatment Refusal / Q000331:legislation & jurisprudence*