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Cited by 25Palliative Care and End-of-Life IssuesHealthcare Decision-Making and RestraintsEthics and bioethics in healthcare

Management of patients with an advance decision and suicidal behaviour: a systematic review

Open access
Nowland, Rebecca, Steeg, Sarah, Quinlivan, Leah M, Cooper, Jayne, Huxtable, Richard, Hawton, Keith, Gunnell, David, Allen, Neil +2 more·2019·BMJ Open
DOI 10.1136/bmjopen-2018-023978PMC PMC6429970
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Abstract

Background: The use of advance care planning and advance decisions for psychiatric care is growing. However, there is limited guidance on clinical management when a patient presents with suicidal behaviour and an advance decision and no systematic reviews of the extant literature. Objectives: To synthesise existing literature on the management of advance decisions and suicidal behaviour. Design: A systematic search of seven bibliographic databases was conducted to identify studies relating to advance decisions and suicidal behaviour. Studies on terminal illness or end-of-life care were excluded to focus on the use of advance decisions in the context of suicidal behaviour. A textual synthesis of data was conducted, and themes were identified by using an adapted thematic framework analysis approach. Results: Overall 634 articles were identified, of which 35 were retained for full text screening. Fifteen relevant articles were identified following screening. Those articles pertained to actual clinical cases or fictional scenarios. Clinical practice and rationale for management decisions varied. Five themes were identified: (1) tension between patient autonomy and protecting a vulnerable person, (2) appropriateness of advance decisions for suicidal behaviour, (3) uncertainty about the application of legislation, (4) the length of time needed to consider all the evidence versus rapid decision-making for treatment and (5) importance of seeking support and sharing decision-making. Conclusions: Advance decisions present particular challenges for clinicians when associated with suicidal behaviour. Recommendations for practice and supervision for clinicians may help to reduce the variation in clinical practice.

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  • Variability in outcome following cardiac arrest has been described in both IHCA and OHCA.

    “Variability in outcome following cardiac arrest has been described in both IHCA and OHCA. 217,285,286,291,292”

    From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [217]

    The Results (Textual synthesis; page not available) describe outcomes in cases involving advance decisions and suicidal behaviour, not outcomes following cardiac arrest. Searches for IHCA, OHCA, and in-hospital and out-of-hospital cardiac arrest found no passage addressing variability in those outcomes. (LLM, conf=0.77)

    Experimental — accuracy not yet measured

  • Epidemiological data provides information on outcome at the population level.

    “Epidemiological data provides information on outcome at the population level. 217,285,286”

    From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [217]

    The Methods describe a narrative synthesis of clinical cases, while the Discussion (Future directions; page unavailable) suggests that prevalence research could establish how often such cases occur. Neither passage addresses whether epidemiological data provide information on outcomes at the population level. Searches for the claim and for population-level outcomes found no supporting passage. (LLM, conf=0.73)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 35

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Cited by

Sorted by citations

Authors
Nowland, R., Steeg, S., Quinlivan, L. M., Cooper, J., Huxtable, R., Hawton, K., Gunnell, D., Allen, N., Mackway-Jones, K., & Kapur, N.
Affiliations
  • University of Manchester (GB)
  • University of Bristol (GB)
  • Warneford Hospital (GB)
  • Manchester Royal Infirmary (GB)
  • Greater Manchester Mental Health NHS Foundation Trust (GB)
Corresponding author
Nowland, Rebecca
ORCID
Venue
BMJ Open
Publisher
BMJ
Published
2019-03
Volume
9
Issue
3
Pages
e023978
ISSN
2044-6055 (ISSN-L)
DOI
10.1136/bmjopen-2018-023978
PMC
PMC6429970
OpenAlex
W2907597230
Cited by
25
References
7
Citations by year
2025: 6 · 2024: 6 · 2023: 2 · 2021: 5 · 2020: 5 · 2019: 1
FWCI
0.45
Type
journal article
Language
en
Update notices
correction (2019-05-05)
Open access
Licence
cc-by
Locations
  • BMJ Open (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research Explorer (The University of Manchester) (publishedVersion, cc-by)
  • Bristol Research (University of Bristol) (publishedVersion, cc-by)
  • CLOK (University of Central Lancashire) (acceptedVersion)
  • HighWire Press Open Archive (submittedVersion)
  • Explore Bristol Research (submittedVersion, cc-by)
Funders
National Institute of Health
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
Keywords
advance decisions, advance care planning, suicidal behavior, psychiatric nursing, patient autonomy, vulnerable populations, clinical decision-making, legislation, shared decision-making, clinician support
MeSH terms
Clinical Decision-Making, Humans, Suicide, Attempted, Mental Competency, Advance Care Planning, Uncertainty

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