Effects of advance care planning on end-of-life decisions among community-dwelling elderly people and their relatives: a systematic review and meta-analysis

Wang, Jingxi; Zhou, Aiting; Hui, Pei; Zhu, Nanxi; Yang, Linhua; Zheng, Xin; Li, M.; Xie, Ning; Deng, Renli

doi:10.21037/apm-23-367

Cited by 1 publication

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“…Furthermore, ACP aims to define and discuss goals and preferences for future medical treatment and care [ 6 ]. In a recent meta-analysis, Wang et al [ 7 ] found that ACP improves the end of life of older adults. Timely documentation of the preferred places of care and death may result in less healthcare consumption and a better match between the preferred and actual places of death among older patients with cancer [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Advance care planning with older Norwegian adults in their homes: a narrative ethnographic study

Festvåg,

Sverre,

Paulsen

et al. 2024

BMC Palliat Care

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Background The aim of advance care planning (ACP) is to enable patients to define and discuss their values and preferences to ensure that the care they receive is consistent with their needs and wishes. Most studies of ACP with older adults focus on conversations conducted in institutions. This study aimed to explore how ACP with older patients is carried out and experienced by healthcare professionals when the conversations occur in their private homes. Methods The data were obtained from participant observations of ACP conversations in the homes of eight older patients with advanced cancer, which also involved relatives and healthcare professionals. Additionally, ethnographic interviews were conducted with the healthcare professionals. We undertook a narrative analysis of what was said, and how the individuals acted and interacted. Results The home influenced both the substance and form of the ACP conversations. The patients and relatives welcomed the healthcare professionals as guests and were encouraged to share their perceptions of their current situation, joys and worries. Their values were often implicit in their stories about past experiences. The planning mainly focused on life-prolonging treatment and the preferred future place of care. Several patients were not ready to discuss one or more ACP issues. The palliative-care-team physician addressed the patients’ readiness for ACP by asking for permission to move on to a different topic, shifting between serious and lighter topics, and using elements from the home as ‘door openers’ to continue conversations. ACP conversations were an essential basis for future palliative care and cooperation, giving important additional information about the patient and their relatives. Conclusion Conducting the ACP conversations in the patients’ homes ensured a homely atmosphere that facilitated a caring approach when sensitive issues were discussed, and in turn supported the identification of important personal values. The healthcare professionals expressed that the ACP conversations represented an essential common reference point and provided a shared awareness of the expected disease trajectory and the values, preferences and needs of the patient. These findings are particularly important given that many older patients struggle to verbalize or form an opinion on issues affecting their future.

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Section: Introductionmentioning

confidence: 99%