title: A review of barriers to using psychiatric advance directives in clinical practice.
abstract: Despite advocacy and demand for psychiatric advance directives (PADs), uptake and implementation in clinical practice is low. We examine why PAD implementation has been difficult globally by reviewing barriers in existing evidence. The review includes 30 studies, and identified 13 barriers, clustered into system level barriers, health professional level barriers, and service user level barriers. The considerable barriers to uptake and implementation hamper PAD use. We propose several potential strategies for overcoming some of the barriers. In order to realise these strategies, additional research is needed, particularly more field-based and operational research to understand processes and difficulties experienced in clinical practice.
authors.affiliation: Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands, laurasshields@gmail.com.
authors.forename: Laura S
authors.initials: LS
authors.lastname: Shields
authors.forename: Soumitra
authors.initials: S
authors.lastname: Pathare
authors.forename: A J
authors.initials: AJ
authors.lastname: van der Ham
authors.forename: Joske
authors.initials: J
authors.lastname: Bunders
mesh_terms: D016223:Advance Directives / Q000706:statistics & numerical data*; D006801:Humans; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy; D008605:Mental Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D016730:Program Development