title: Reducing barriers to completing psychiatric advance directives.
abstract: OBJECTIVE
  Psychiatric advance directives (PADs) allow individuals to plan for future mental health treatment. However, little is known about barriers to PAD completion. This paper examines an intervention's effect in reducing barriers to PAD completion.
  
  
  METHODS
  Patients were randomly assigned to a facilitated PAD session or control group. Barriers associated with (1) the PAD documents and (2) external support for PADs were assessed at baseline (n = 462), 6 months (n = 380) and 1 year (n = 362).
  
  
  RESULTS
  There were no significant baseline between-group differences on the two barriers. However, at follow-up both barriers were significantly lower in the experimental group. Further, barriers were predictive of PAD completion.
  
  
  CONCLUSIONS
  Structured facilitation can significantly reduce barriers to PAD completion. However, the intervention did not eliminate barriers. Findings are discussed in the context of possible system-level changes to further reduce barriers to PAD completion.
authors.affiliation: College of Social Work, Justice, and Public Affairs, Florida International University, University Park Campus, 11200 SW 8th Street GL 484, Miami, FL 33199, USA. richard.vandorn@fiu.edu
authors.forename: Richard A
authors.initials: RA
authors.lastname: Van Dorn
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Swanson
authors.forename: Marvin S
authors.initials: MS
authors.lastname: Swartz
authors.forename: Eric
authors.initials: E
authors.lastname: Elbogen
authors.forename: Joelle
authors.initials: J
authors.lastname: Ferron
mesh_terms: D016223:Advance Directives; D001714:Bipolar Disorder / Q000628:therapy*; D003657:Decision Making; D003865:Major Depressive Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009657:North Carolina; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D012559:Schizophrenia / Q000628:therapy*; D012944:Social Support