Elbogen Eric B, Swanson Jeffrey W, Appelbaum Paul S, Swartz Marvin S, Ferron Joelle, Van Dorn Richard A, Wagner H Ryan
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.
Law Hum Behav. 2007 Jun;31(3):275-89. doi: 10.1007/s10979-006-9064-6.
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.
精神科预先指示（PADs）法规假定有能力完成这些文件，但实际完成PADs的人群中决策能力的范围和维度尚不清楚。本研究考察了一项评估完成PADs能力的测试中表现的临床和神经心理学相关因素，并调查了一项辅助性PAD干预措施对决策能力的影响。469名患有精神疾病的成年人在基线时接受了访谈，然后被随机分配到对照组（他们收到有关PADs的书面材料）或干预组（他们有机会与一名经过培训的协助者单独会面以制定一份PAD）。在基线时，PADs决策能力评估工具（DCAT-PAD）上的各个领域与智商、言语记忆、抽象思维和精神症状关联最为紧密。在1个月的随访中，干预组的参与者在DCAT-PAD上的改善比对照组更多，尤其是在病前智商估计低于中位数100的参与者中。结果表明，辅助制定PADs是一种有效的方法，可以提高认知受损患者制定PADs以及在PADs范围内做出治疗决策的能力，从而最大程度地提高他们的预先指示有效的可能性。
