Barriers and facilitators for mental-health professionals in the management and implementation of advance directives
Bibliographic Data
| ID | 21458866 |
|---|---|
| Authors | Sergio Ramos-Pozón (Universitat de Barcelona), Anna Falcó-Pegueroles (Universitat de Barcelona, corresponding author), Silvia Poveda-Moral (Universitat de Barcelona), Hilari Andrés-Mora (Parc Sanitari Sant Joan de Déu), Raquel Fabregat-Marcos (Parc Sanitari Sant Joan de Déu), Ramon Mir-Abellan (Parc Sanitari Sant Joan de Déu), Luisa Baladón-Higueras (Parc Sanitari Sant Joan de Déu), Begoña Roman (Universitat de Barcelona), Bernabé Robles (Parc Sanitari Sant Joan de Déu), Eva Garrido-Aguilar (Universitat de Barcelona) |
| Year | 2026 |
| Volume | 107 |
| Pages | 102224 |
| Publication date | 2026-07-01 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | International Journal of Law and Psychiatry (JOURNAL) |
| Journal identifiers | ISSN: 0160-2527 • E-ISSN: 1873-6386 |
| Publisher | Elsevier BV (PUBLISHER) |
| DOI | 10.1016/j.ijlp.2026.102224 |
| PMID | 41926838 |
| OpenAlex | W7147735871 |
| Language | EN |
| References cited | 46 |
BACKGROUND: The Advance Directive (AD) serves as a fundamental legal and ethical instrument for safeguarding patient autonomy, ensuring that clinical decisions align with individual values when decision-making capacity is compromised. Despite the established legal framework in Spain since 2002, its practical implementation within mental health services remains largely under-researched. The objective of our study is to describe the barriers and facilitators perceived by mental-health professionals regarding the clinical management and implementation of the Advance Directive (AD). METHODS: A descriptive, cross-sectional study was executed between December 2022 and March 2023 at Parc Sanitari Sant Joan de Déu (Barcelona, Spain). The sample comprised 215 healthcare professionals across various disciplines-including nursing, psychiatry, psychology, and social work-representing a participation rate of approximately 20% of the 1035 eligible institutional staff. FINDINGS: Results reveal a profound discrepancy between theoretical appraisal and clinical practice. Although 96.7% of professionals acknowledge the utility of the AD, practical engagement remains residual: only 20.0% of participants report direct experience with a patient's document. Critical operational barriers were identified, as 74.4% of respondents were unfamiliar with procedures for retrieving an AD from the official registry. Furthermore, 71.6% of professionals perceive an absence of adequate technical or administrative resources provided by their institution. Conversely, facilitators are rooted in ethical commitment; 88.3% maintain that a patient's anticipatory wishes should be respected even when they conflict with clinical advice. CONCLUSIONS: Findings underscore a significant gap between the ethical-legal ideal of autonomy and its clinical execution within the Spanish mental health context. Positive professional attitudes are insufficient without robust systemic support. Effective implementation necessitates a multidimensional strategy: strengthening specialized continuing education, streamlining access protocols within electronic health records, and fostering institutional policies that prioritize patient-centered psychiatric care
Health professionals · MEDLINE · Occupational safety and health · Poison control · Healthcare Decision-Making and Restraints · Human Factors and Ergonomics · Interprofessional Education and Collaboration · Palliative Care and End-of-Life Issues
| Highly cited | No |
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