A template for a psychiatric advance directive: Co-development and qualitative evaluation with key stakeholders

IF 1.3 4区医学 Q1 LAW

International Journal of Law and Psychiatry Pub Date : 2025-08-05 DOI:10.1016/j.ijlp.2025.102135

Anne-Sophie Gaillard , Jakov Gather , Iris Haferkemper , Jochen Vollmann , Sarah Potthoff , Matthé Scholten , Esther Braun

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引用次数: 0

Abstract

Background

Psychiatric advance directives (PADs) allow mental health service users to express their treatment preferences for future mental health crises. An accessible template for PADs can improve their implementation in practice.

Aim

Developing and evaluating a PAD template tailored to the German context together with key stakeholders.

Method

We co-developed a prototype PAD template based on a systematic review of the content of PADs and a review of existing templates in consultation with our research group's lived experience council. The prototype was evaluated in 5 focus groups with service users, relatives, mental healthcare professionals, peer support workers and legal guardians as well as 4 consultation sessions with clinical and legal experts and the research group's lived experience council. We revised the template after each feedback round.

Results

Participants valued the inclusion of the options to articulate personal values, preferred types of support in their recovery process, and preferred measures of supported decision-making in the template. They recommended including a summary page with the most important information in a crisis, a section for service users to describe themselves when stable or well, and the option to state preferences for post-inpatient care. There was controversy among study participants on whether the template should include individual indicators of decision-making capacity, preferences regarding treatment setting, and de-escalation strategies.

Conclusions

This study presents the development of the first German PAD template together with key stakeholders. The study design can be used as a model for developing templates tailored to other legal contexts.

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精神病学预先指示的模板：与关键利益相关者共同发展和定性评估

精神病学预先指示（pad）允许心理健康服务使用者表达他们对未来心理健康危机的治疗偏好。一个可访问的pad模板可以在实践中改进它们的实现。目的与主要利益相关者一起开发和评估适合德国环境的PAD模板。方法我们在系统回顾PAD内容的基础上，与我们研究组的生活经验委员会协商对现有模板的回顾，共同开发了一个PAD原型模板。该原型在5个焦点小组中进行了评估，其中包括服务使用者、亲属、精神保健专业人员、同伴支持工作者和法定监护人，以及与临床和法律专家以及研究小组的生活经验委员会进行了4次咨询。我们在每一轮反馈后修改模板。结果参与者重视在模板中包含表达个人价值观的选项，在恢复过程中首选的支持类型，以及支持决策的首选措施。他们建议包括一个总结页面，其中包含危机中最重要的信息，服务用户在稳定或健康时描述自己的部分，以及说明对住院后护理的偏好。研究参与者对模板是否应该包括决策能力、治疗设置偏好和降级策略的个人指标存在争议。本研究与主要利益相关者一起提出了第一个德国PAD模板的发展。研究设计可以用作开发适合其他法律背景的模板的模型。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Law and Psychiatry Multiple-

CiteScore

4.70

自引率

8.70%

发文量

审稿时长

41 days

期刊介绍： The International Journal of Law and Psychiatry is intended to provide a multi-disciplinary forum for the exchange of ideas and information among professionals concerned with the interface of law and psychiatry. There is a growing awareness of the need for exploring the fundamental goals of both the legal and psychiatric systems and the social implications of their interaction. The journal seeks to enhance understanding and cooperation in the field through the varied approaches represented, not only by law and psychiatry, but also by the social sciences and related disciplines.