Evidence map›Paper›PMID 31530303›Full record

ArticleBJPsych open2019

Advance decisions to refuse treatment and suicidal behaviour in emergency care: 'it's very much a step into the unknown'.

Leah Quinlivan, Rebecca Nowland, Sarah Steeg, Jayne Cooper, Declan Meehan, Joseph Godfrey, Duncan Robertson, Damien Longson, John Potokar, Rosie Davies and 6 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BJPsych open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
0.5field-weighted citation impact, top 28% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 7 citations in OpenAlex.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors at 10 institutions in 1 country.

Leah QuinlivanResearch Associate, Centre for Suicide Prevention, Manchester Academic Health Science Centre, University of Manchester; and NIHR Greater Manchester Patient Safety Translational Research Centre, UK.ORCID https://orcid.org/0000-0002-3944-3613
Rebecca NowlandResearch Associate, Centre for Suicide Prevention, Manchester Academic Health Science Centre, University of Manchester, UK.
Sarah SteegResearch Associate, Centre for Suicide Prevention, Manchester Academic Health Science Centre, University of Manchester, UK.
Jayne CooperSenior Research Fellow, Centre for Suicide Prevention, Manchester Academic Health Science Centre, University of Manchester, UK.
Declan MeehanSenior Mental Health Practitioner and Operational Manager, Greater Manchester Mental Health NHS Foundation Trust, UK.
Joseph GodfreyEmergency Medicine Consultant, Emergency Department, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, UK.
Duncan RobertsonSenior Paramedic, North West Ambulance Service, UK.
Damien LongsonConsultant Psychiatrist, Greater Manchester Mental Health NHS Foundation Trust, UK.
John PotokarConsultant Psychiatrist, Avon and Wiltshire Mental Health Partnership NHS Trust; University Hospitals Bristol NHS Foundation Trust; and Department of Population Health Sciences, University of Bristol, UK.
Rosie DaviesResearch Fellow, The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust; and Faculty of Health and Applied Sciences, University of the West of England, UK.
Neil AllenBarrister and Senior Lecturer, School of Law, University of Manchester, UK.
Richard HuxtableProfessor of Medical Ethics and Law, Department of Population Health Sciences, University of Bristol, UK.
Kevin Mackway-JonesEmergency Medicine Consultant, Emergency Department, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, UK.
Keith HawtonProfessor of Psychiatry, Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, UK.
David GunnellProfessor of Epidemiology, Department of Population Health Sciences, University of Bristol; and National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, UK.
Nav KapurProfessor of Psychiatry and Population Health and Honorary Consultant Psychiatrist, Centre for Suicide Prevention, Manchester Academic Health Science Centre, University of Manchester; NIHR Greater Manchester Patient Safety Translational Research Centre; and Greater Manchester Mental Health NHS Foundation Trust, UK.
Manchester Academic Health Science Centre · GBGreater Manchester Mental Health NHS Foundation Trust · GBManchester Royal Infirmary · GBAvon and Wiltshire Mental Health Partnership NHS Trust · GBNorth West Ambulance Service NHS Trust · GBUniversity Hospitals Bristol NHS Foundation Trust · GBUniversity of Bristol · GBUniversity of Manchester · GBUniversity of the West of England · GBWarneford Hospital · GB

Funding

Department of Health RP-PG-0610-10026
6 · The paper itself

Abstract

backgroundComplex challenges may arise when patients present to emergency services with an advance decision to refuse life-saving treatment following suicidal behaviour.

aimsTo investigate the use of advance decisions to refuse treatment in the context of suicidal behaviour from the perspective of clinicians and people with lived experience of self-harm and/or psychiatric services.

methodForty-one participants aged 18 or over from hospital services (emergency departments, liaison psychiatry and ambulance services) and groups of individuals with experience of psychiatric services and/or self-harm were recruited to six focus groups in a multisite study in England. Data were collected in 2016 using a structured topic guide and included a fictional vignette. They were analysed using thematic framework analysis.

resultsAdvance decisions to refuse treatment for suicidal behaviour were contentious across groups. Three main themes emerged from the data: (a) they may enhance patient autonomy and aid clarity in acute emergencies, but also create legal and ethical uncertainty over treatment following self-harm; (b) they are anxiety provoking for clinicians; and (c) in practice, there are challenges in validation (for example, validating the patient's mental capacity at the time of writing), time constraints and significant legal/ethical complexities.

conclusionsThe potential for patients to refuse life-saving treatment following suicidal behaviour in a legal document was challenging and anxiety provoking for participants. Clinicians should act with caution given the potential for recovery and fluctuations in suicidal ideation. Currently, advance decisions to refuse treatment have questionable use in the context of suicidal behaviour given the challenges in validation. Discussion and further patient research are needed in this area. DECLARATION OF INTEREST: D.G., K.H. and N.K. are members of the Department of Health's (England) National Suicide Prevention Advisory Group. N.K. chaired the National Institute for Health and Care Excellence (NICE) guideline development group for the longer-term management of self-harm and the NICE Topic Expert Group (which developed the quality standards for self-harm services). He is currently chair of the updated NICE guideline for Depression. K.H. and D.G. are NIHR Senior Investigators. K.H. is also supported by the Oxford Health NHS Foundation Trust and N.K. by the Greater Manchester Mental Health NHS Foundation Trust.

Indexed as

emergency servicesmental capacityMental Capacity ActSelf-harmsuicidal behaviour

Identifiers

PMID31530303
PMCPMC6582215
OpenAlexW2952400091

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-SA
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.