Educational Intervention to Increase Provider-Initiated Use of Psychiatric Advance Directives

Introduction: Mental health providers lack knowledge and training about psychiatric advance directives (PADs) which is a barrier to patient completion. The purpose of this study was to determine if an educational intervention with outpatient mental health providers would increase provider-reported initiative to discuss PADs with patients and result in patients completing PADS. Method: An educational intervention was completed at a large Veterans Affairs outpatient mental health clinic. A pre-post intervention, and follow-up design was used to evaluate providers' levels of education, comfort, and perceived importance of PADs. Intervention: An educational in-service was offered to outpatient mental health providers on PADs. Participants attended a provider meeting that included psychiatrists and advanced practice registered nurses. A questionnaire was given to the providers before the in-service, immediately after, and one month after the intervention. Results: Fifteen participants completed the pretest and posttest for the educational intervention. Six of the 15 participants completed a one-month follow-up survey. After the brief educational intervention, providers reported feeling more educated (pre-post mean 2, 3.67, p = 0.2) and more comfortable discussing PADs with patients (pre-post mean 2.8, 3.57, p. = 0.06). There was no significant change in perceived importance of PADs in the providers (pre-post mean 4, 3.87, p = 0.08). At the one-month follow-up, providers continued to report feeling more educated (mean 3.33) and comfortable (mean 3) discussing PADs; however, no provider reported having a patient complete a PAD.