Efficacy of Advance Care Planning: A Systematic Review and Meta-Analysis |
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| Institution: | 1. Program Development Center, Center of Expertise for Chronic Organ Failure (CIRO+), Horn, The Netherlands;2. Respiratory Medicine, Maastricht UMC+, Maastricht, The Netherlands;3. Center of Expertise for Palliative Care, Maastricht UMC+, Maastricht, The Netherlands;1. Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, Chapel Hill, North Carolina;2. Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;3. Healthy Aging Program, Applied Research and Translation Branch, Division of Population Health, CDC;4. Emory University Rollins School of Public Health, Atlanta, Georgia;1. Department of Pain and Palliative Care, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia;2. Departments of Oncology and Medicine, The University of Melbourne, Melbourne, Victoria, Australia;3. Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia;4. Hammond Care Palliative and Supportive Care Service, Greenwich Hospital, Sydney, New South Wales, Australia;5. Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia;1. San Francisco Veterans Affairs Medical Center, San Francisco, California, USA;2. Division of Geriatrics, University of California, San Francisco, California, USA;3. Department of Psychiatry, University of California, San Francisco, California, USA;4. Department of Epidemiology & Biostatistics, University of California, San Francisco, California, USA;5. Health Services Research & Development Service, Veterans Administration, Washington, D.C., USA;6. People Designs, Inc., Durham, North Carolina, USA;1. Improving Palliative Care through Clinical Trials, New South Wales, Australia;2. Faculty of Health, University of Technology Sydney, Sydney, Australia;3. South Western Sydney Clinical School, University of New South Wales, Sydney, Australia;4. Respecting Patient Choices, Austin Health, Melbourne, Australia;5. CareSearch, Flinders University, South Australia, Australia;6. Sydney Medical School, University of Sydney, Sydney, Australia;7. Department of Renal Medicine, Royal North Shore Hospital, Sydney, Australia;8. School of Psychology, University of Sydney, Sydney, Australia;9. Department of Renal Medicine and Palliative Care, St George Hospital, Sydney, Australia;10. HammondCare Palliative & Supportive Care Service, Greenwich Hospital, Sydney, Australia |
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| Abstract: | ObjectiveTo systematically review the efficacy of advance care planning (ACP) interventions in different adult patient populations.DesignSystematic review and meta-analyses.Data SourcesMedline/PubMed, Cochrane Central Register of Controlled Trials (1966 to September 2013), and reference lists.Study SelectionRandomized controlled trials that describe original data on the efficacy of ACP interventions in adult populations and were written in English.Data Extraction and SynthesisFifty-five studies were identified. Study details were recorded using a predefined data abstraction form. Methodological quality was assessed using the PEDro scale by 2 independent reviewers. Meta-analytic techniques were conducted using a random effects model. Analyses were stratified for type of intervention: ‘advance directives’ and ‘communication.’Main Outcomes and MeasuresPrimary outcome measures were completion of advance directives and occurrence of end-of-life discussions. Secondary outcomes were concordance between preferences for care and delivered care, knowledge of ACP, end-of-life care preferences, quality of communication, satisfaction with healthcare, decisional conflict, use of healthcare services, and symptoms.ResultsInterventions focusing on advance directives as well as interventions that also included communication about end-of-life care increased the completion of advance directives and the occurrence of end-of-life care discussions between patients and healthcare professionals. In addition, interventions that also included communication about ACP, improved concordance between preferences for care and delivered care and may improve other outcomes, such as quality of communication.ConclusionsACP interventions increase the completion of advance directives, occurrence of discussions about ACP, concordance between preferences for care and delivered care, and are likely to improve other outcomes for patients and their loved ones in different adult populations. Future studies are necessary to reveal the effective elements of ACP and should focus on the best way to implement structured ACP in standard care. |
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| Keywords: | Advance care planning end-of-life care communication advance directives |
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