Electronic Advance Care Planning in Community: Nurses' role

Overview of Systematic Reviews of Advance Care Planning: Summary of Evidence and Global Lessons

“…There is a diversity in policy approaches to ACP across, and even within, countries. 37 The lack of a clear legal framework creates confusion about the legal status of ACP and hinders ACP implementation, 38 causing patients and family members to question its utility. Hence, ACP needs to be supported by strong policy initiatives at the health system and at the institutional level, as reflected by positive changes in staff, family, and patient outcomes after EOL policy implementation through the likes of the Patient Self-Determination Act in the U.S. and the Golden Standard Framework for Care Homes in the U.K. 39,40 On the one hand, health system policies need to be directed at the ground level of service provision, as best clinical practices without systemic support are unlikely to produce positive change.…”

“…The SRs that did not differentiate between individual types of interventions reported that ACP that was broadly conceptualized was associated with increased documentation of EOL preferences, as well as increased use and completion rates of durable powers of attorneys or ADs, 92 which helped shift decision responsibility from health care teams to patients and their families. 53 ACP was also beneficial at increasing EOL discussions with patients, family members, and physicians, 19,37,55,71,92 clarifying patients' choices and raising awareness, 55 and improving communication between patients and clinicians, 19 and between nursing homes and hospitals. 71 ACP interventions were also found to increase patients' and families' satisfaction with care and giving patients stronger feelings of being ''cared for'' and ''in control,'' which provided a greater peace of mind and a sense of relief.…”