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Open research questions in Healthcare Decision-Making and Restraints

67 unresolved questions extracted from the limitations and future-work sections of 1,595 Healthcare Decision-Making and Restraints papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • ABSTRACT Background Informed consent is a cornerstone of modern medicine, yet the extent to which patients truly understand surgical information in the perioperative setting remains uncertain, particularly among older and vulnerable populations.

    Informed Consent in Orthopaedic Surgery: When a Signature Does Not Mean Understanding: A Prospective Study of 750 Patients Comparing Elective and Trauma Settings · 2026 · DOI

  • Expanding involuntary hospitalization is not sufficient to support long-term treatment for people with severe mental health issues. This paper advocates for alternative proposals, including allocating funding for Assertive Community Treatment programs, strengthening cultural competency in mental health care, providing complete discharge planning and continuity of care, and improving the quality of care at inpatient psychiatric hospitals. ALLOCATE FUNDING FOR ASSERTIVE COMMUNITY TREATMENT PROGRAMS Evidence-based community mental health treatments are more cost-effective and can reduce acute care and hospital stays (Saunders & Rudowitz, 2025). Assertive Community Treatment (ACT) is an accessible form of treatment that can effectively address psychosocial complexities and improve social determinants of health (Balasuriya et al., 2020). ACT involves mobile, evidence-based, intensive, multidisciplinary teams that deliver 24/7 care for people with serious mental illness at risk of psychiatric crisis and hospitalization (Duch et al., 2025). ACT services include psychiatric evaluation, medication management, therapy, supported employment, supported housing, case management, and peer support (Duch et al., 2025). 46 | COLUMBIA SOCIAL WORK REVIEW, VOL. XXIV STEPHANIE CHENG Though ACT is considered an alternative to decrease inpatient care costs, the cost can still be substantial due to its intensive nature, costing an average of $21,481 per person per year, which can limit the extent of its usage (Duch et al., 2025). But these costs will be offset and will decrease in the long term, as inpatient admissions and criminal justice system–related expenses will decrease and use of regular outpatient care will increase (Duch et al., 2025). Value-based payment based on provider performance has been shown to decrease expenditures for ACT and shift high-cost inpatient expenditures to community-based care (Duch et al., 2025). STRENGTHEN CULTURAL COMPETENCY IN MENTAL HEALTH CARE Increased diversity and collaborative care can foster trust in mental health services for people of color with severe mental illness (Maura & Weisman de Mamani, 2017). Integrating cultural perspectives and increasing patients’ involvement in treatment decisions can improve treatment engagement. This can include asking patients about their preferences on treatment and providing options (Maura & Weisman de Mamani, 2017). Cultural competency training can strengthen communication with patients and avoid stigmatizing them (McGregor et al., 2019). Care providers need to maintain cultural humility through ongoing self-reflection and adaptation, and reflect on their own biases and cultural identities, which can affect how they interact with patients (Delfish & Chadha, 2025). Providers can limit implicit bias by attending workshops or seminars to broaden their knowledge about cultural diversity in mental health care (Delfish & Chadha, 2025).

    Policy Analysis of Involuntary Psychiatric Hospital Admission in New York · 2026 · DOI

  • The substituted judgment standard emerged within Anglo-American bioethics and legal theory as an attempt to extend patient autonomy beyond the loss of decisional capacity. Rather than determining what is objectively best for the patient — the alternative best interests standard — it requires the surrogate to reconstruct the decision the patient would have made under current circumstances. The normative ambition 1 3B. Nikolic is substantial: it treats incapacitated patients as subjects with continuing autonomous histories rather than as objects of beneficent intervention. The model’s philosophical presuppositions are demanding. It assumes that patients possess coherent and stable values, that those values have been adequately communicated to and retained by surrogates, and that surrogates are willing and able to set aside their own preferences in favour of faithful reconstruction. Advance directives represent the paradigmatic institutional expression of this aspiration: a mechanism by which patients may speak prospectively into situations they may not be able to address in the moment. The epistemic difficulties of the model are well documented. Patients rarely articulate preferences for every clinically relevant scenario, requiring surrogates to extrapolate from fragmentary evidence. Empirical research has consistently demonstrated that surrogate decision-makers frequently misjudge patient preferences even when acting in demonstrable good faith (Shalowitz et al. 2006, Fagerlin et al. 2004, Rid and Wendler 2014). Reconstruction is necessarily interpretive, and interpretation is subject to systematic distortion. Buchanan and Brock’s foundational account acknowledges these difficulties while maintaining that substituted judgment remains normatively preferable to abandoning the aspiration of autonomy-preservation altogether (Buchanan and Brock 1989, Sulmasy and Snyder 2010). Philosophical accounts of relational autonomy have further enriched this picture. Mackenzie and Stoljar’s influential framework emphasises that autonomy is not merely an intrinsic property of individual agents but a condition that can be supported or undermined by social relationships and institutional structures (Mackenzie and Stoljar 2000). Pellegrino’s virtue-based account of clinical medicine directs attention to the dispositional character of the practitioner as an essential component of ethically adequate care — a dimension that procedural frameworks alone cannot fully capture (Pellegrino and Thomasma 1993). O’Neill’s analysis of trust in bioethics argues that autonomy-respecting procedures must take seriously the conditions under which trust can be legitimately extended or withheld (O’Neill 2002). What these accounts have examined less thoroughly is a distinct form of failure: motivational corruption at the level of the surrogate relationship itself.

    Autonomy under uncertainty: the structural limits of substituted judgment in clinical practice · 2026 · DOI

  • Future research should focus on multisite and mixed-methods studies to examine the prevalence, determinants, and outcomes of restraint, evaluate the effectiveness and implementation of restraint-reduction strategies and alternatives in resource-limited settings, and gener- ate comparative evidence across Tanzania and sub-Saharan Africa to inform context-appropriate, rights-based policies and practice.

    Patients’ experiences and perceptions of physical restraint in psychiatric care: A descriptive qualitative study at Muhimbili National Hospital · 2026 · DOI

  • Our aims in this article are to 1) describe and review the literature related to the effects of interventions to prevent and manage aggression and violence in inpatient and residential youth facilities, 2) describe and review the literature on the effects of R&S and experiences of youth and staff, related to youth violence, R&S, and 3) identify potential gaps in knowledge about these issues that future research could narrow or close.

    Conflict prevention, de-escalation and restraint in children/youth inpatient and residential facilities: A systematic mapping review · 2021 · DOI

  • Although work is being done to integrate physical and behavioral health care in order to address the primary health-care needs of persons with SMI, very little is known about their health-care behaviors and how they make their treatment decisions.

    Physical Health Decision-Making Autonomy Preferences for Adults with Severe Mental Illness in Integrated Care · 2016 · DOI

  • This qualitative study examined the client experience of psychiatric medication among an unusual and under-studied subpopulation, individuals diagnosed with SMI who eventually experienced functional recovery.

    The client experience of psychiatric medication: A qualitative study · 2015 · DOI

  • These results suggest that additional work is needed to expand our understanding of the role of EMS providers in the care of people with behavioral health problems and that mental health practitioners and policy makers should include consideration of the important role of EMS and prehospital care in providing community-based supports for people with behavioral health needs.

    Emergency medical services and “psych calls”: Examining the work of urban EMS providers. · 2015 · DOI

  • 12 Educational programs have been found by some authors to reduce restraints; however, Möhler and colleagues concluded in their Cochrane review that insufficient evidence supports the effectiveness of educational interventions to reduce restraint use.

    Reducing restraint use for older adults in acute care · 2013 · DOI

  • RESULTS AND CONCLUSION: The frequency of psychiatric emergencies in non-psychiatric settings, such as general hospitals and doctors' offices, and their treatment are poorly documented by the few controlled studies and sparse reliable data that are now available.

    The Management of Psychiatric Emergencies · 2011 · DOI

  • A few studies have found IOP treatment to be beneficial in care of borderline personality disorder (Gratz, Lacroce, & Gunderson, 2006; Smith, Ruiz-Sancho, & Gunderson, 2001).

    Long-Term Outcomes of an Intensive Outpatient Program for Missionaries and Clergy · 2011

  • Abstract The reasons for the problems created by deinstitutionalization have only recently become clear; these include a lack of consensus about the movement, no real testing of its philosophic bases, the lack of planning for alternative facilities and services (especially for a population with notable social and cognitive deficits), and the inadequacies of the mental health delivery system in general.

    Deinstitutionalization: Avoiding the disasters of the past · 1988 · DOI

  • However, their application in Brazil remains limited by the absence of specific federal legislation, insufficient professional knowledge, legal uncertainty, and the lack of institutional protocols.

    ADVANCE DIRECTIVES: A LITERATURE REVIEW OF ETHICAL, LEGAL, AND CLINICAL ASPECTS · 2026 · DOI

  • While there are a growing number of anecdotal reports of supported decision-making being used with success, there is not yet a robust evidence base either showing its efficacy or what factors or practices are associated with its efficacy.

    The Legal Landscape for Supported Decision-Making in the United States and its Application to Clinical Research · 2026 · DOI

  • Findings Whilst efforts to reduce the overmedication of people with learning disabilities are welcomed, there is lacking evidence around this population’s experience of adverse effects from psychiatric deprescribing decisions, including differentiating between withdrawal and relapse effects.

    Commentary on “Stakeholder experiences of deprescribing psychotropic medicines for challenging behaviour in people with intellectual disabilities” · 2024 · DOI

  • We believe that in a context where any timeframe of the current epidemic in Poland remains unknown, familiarity and observance of the recommendations set out by the Ministry of Health is of particular importance.

    Admission to the psychiatric ward of a patient with paranoid syndrome and recommended COVID-19 quarantine: a case report · 2021 · DOI

  • However, there is a gap in the literature regarding the logistics of safely conducting therapeutic interventions and assessments in environments that were not designed for forensic populations, or individuals with intellectual and developmental disabilities as primary diagnoses.

    Clinical Interventions in State Psychiatric Hospitals: Safety and Logistical Considerations · 2020 · DOI

  • Future studies are needed to determine how best to assure that these documents will be correctly prepared and then given over to hospital staff so that they can take their place in the patient's record.

    Advance Directives and Powers of Attorney in Intensive Care Patients · 2017 · DOI

  • End-of-life is not limited to the medical aspect of death; it may include areas such as financial and legacy decisions, creating memorials, attaining a comfortable spiritual acquiescence, and saying goodbye to family and friends.

    Rehabilitation Counselor Ethical Considerations for End-of-Life Care · 2016

  • Future research should address possible strategies for sustaining these improvements and at the same time stabilizing or reducing the number of people receiving restrictive care.

    Practitioner Explanations for the Increasing Use of Restraint Measures in the Care of People With Intellectual Disabilities in <scp>N</scp>orway 2000–11 · 2015 · DOI

  • The impact of being involved in these procedures remains under researched, but there is growing acknowledgment that some form of post incident review should take place after restraint use.

    Postincident Review of Aggression and Violence in Mental Health Settings · 2010 · DOI

  • Also, there is no consensus among jurisdictions about what constitutes dangerousness, though commitment statutes often refer to three criteria: the type of danger, the immediacy of the danger, and the likelihood of the danger.

    The Search for Due Process in Civil Commitment Hearings: How Procedural Realities Have Altered Substantive Standards · 2008

  • Fear of the consequences of consultation warrants attention if general practice is to be promoted as the preferred point of contact for mental health consultations.

    ‘It puts things out of your control’: fear of consequences as a barrier to patient disclosure of mental health issues to general practitioners · 2007 · DOI

  • More remains to be done to make larger scale changes to acute inpatient care and address the growing uncertainty over what role it plays in a modern mental health service.

    The Search for Acute Solutions · 2006 · DOI

  • The needs of patients in medium secure psychiatric units are well documented, but little is known of the range of clinical and security needs of those assessed but put on waiting lists or not admitted.

    Access to medium secure psychiatric care in England and Wales. 3: The clinical needs of assessed patients · 2004 · DOI

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67 open questions have been extracted from the limitations and future-work passages of 1,595 Healthcare Decision-Making and Restraints papers in our library. Each one below links back to the study that raised it, so you can read the original claim in context.

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