A survey of attitudes and knowledge about advance healthcare directives amongst inpatient psychiatry service users in Ireland

Abstract

Objectives: To investigate levels of knowledge and attitudes towards advance healthcare directives among inpatient psychiatry service users in Ireland.

Methods: A survey was completed among adult inpatient psychiatry service users (n = 47) in Tallaght University Hospital, Dublin.

Results: Just over one in ten (11%) inpatient psychiatry service users had heard of advance healthcare directives. None had created an advance healthcare directive, but over a quarter (25.5%) had written down or verbally told someone what they would like to happen when they became unwell. When asked 'if you were supported by your healthcare provider to make an advance healthcare directive, would you like to make one?', over two thirds responded either 'definitely yes' (34%) or 'probably yes' (34%). On multi-variable testing, future willingness to make an advance healthcare directive was significantly associated with younger age but not with ethnicity, gender, education, employment status, or prior knowledge of advance healthcare directives. All respondents would involve someone else in making an advance healthcare directive. There was high confidence that healthcare practitioners would respect an advance healthcare directive (87%).

Conclusions: There are high levels of interest in advance healthcare directives, but low levels of knowledge and use among inpatient psychiatry service users in Ireland. Our findings indicate a need for educational initiatives and resources to increase awareness. Such efforts could usefully focus especially on appropriate use of advance healthcare directives in psychiatric care and seek to bridge the gaps between evidence of benefit, legislative reform, and their use in mental healthcare.

Keywords: Advance healthcare directives; autonomy; future care planning; psychiatry.