Effects of Advance Care Planning on End-of-Life Decision Making: A Systematic Review and Meta-Analysis

Abstract

The purpose of this systematic review and meta-analysis was to investigate the effects of advance care planning on end-of-life decision-making. Methods: Databases including RISS, KISS, KMbase, KoreaMed, PubMed (MEDLINE), Embase, and CINAHL were searched for studies that examined the effects of advance care planning interventions. The inclusion criteria were original studies in English or Korean; adults ≥18 years of age (population); advance care planning (intervention); completion of advance directives (AD) or advance care planning (ACP) (outcomes); and randomized or non-randomized controlled trials (RCTs and non-RCTs, respectively) (design). Study quality was measured using the checklists of the Joanna Briggs Institute. Meta-analyses were conducted with the Comprehensive Meta-Analysis program. Results: Nine RCTs and nine non-RCTs were selected for the final analysis. The effect sizes (ES) of the outcome variables in nine RCTs were meta-analyzed, and found to range from 0.142 to 0.496 for the completion of AD and ACP (ES=0.496, 95% CI: 0.157~0.836), discussion of end-of-life care (ES=0.429, 95% CI:-0.027~0.885), quality of communication (ES=0.413, 95% CI: 0.008~0.818), decisional conflict (ES=0.349, 95% CI:-0.059~0.758), and congruence between preferences for care and delivered care (ES=0.142, 95% CI:-0.267~0.552). Conclusion: ACP interventions had a positive effect on the completion of AD and ACP. To apply AD or ACP in Korea, it is necessary to develop ACP interventions that reflect aspects of Korean culture.

Danish consensus and definition for Advance Care Planning (ACP)

“…Betydningen af ACP I udenlandsk forskningslitteratur har ACP vist sig at kunne øge sandsynligheden for, at patienternes ønsker for fremtidig pleje og behandling bliver registreret og opfyldt (7)(8)(9), samt at patienterne får mindre udsigtsløs behandling og indlaegges mindre i den sidste tid (8)(9)(10). Desuden har udenlandske studier vist, at pårørende er mere tilfredse med pleje og kommunikation med sundhedsprofessionelle i forløbet efter en ACP-samtale (7)(8)(9)(10)(11), at de pårørendes accept af sygdommen er større (12,13) og at der er større sandsynlighed for, at familien snakker mere sammen om deres ønsker for den sidste tid (14). Der ud over er der fundet, at de efterladte pårørende ikke i samme grad føler angst og depression, hvis der har vaeret en ACPsamtale i forløbet (7,11,15).…”

The moderating effect of attitudes in the relationship between knowledge and self-efficacy in palliative care among nurses: A cross-sectional, correlational study

“…In ACP process, an advance directive (AD) can be signed that enables an individual to prepare future palliative and EOL care based upon own personal values and preferences [3,4,[6][7][8]. The planned care reduces personal and societal burdens of care and improves quality of EOL care by reflecting personal desires [8][9][10], more completing an AD and /or documentation of ACP [8][9][10], and less using resources with lower costs during the EOL period [8,11]. Conversely, suboptimal utilization of EOL discussion via ACP and/or ADs often results in patients receiving meaningless aggressive treatments until near death [12] and EOL care against their preferences [8,13,14].…”