The Effect of Advance Care Planning Intervention on Hospitalization Among Nursing Home Residents: A Systematic Review and Meta-Analysis

Pimsen, Apiradee; Kao, Chi-Yin; Hsu, Sheng-Tzu; Shu, Bih‐Ching

doi:10.1016/j.jamda.2022.07.017

Cited by 32 publications

(19 citation statements)

References 48 publications

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“…A summary of the critical appraisal assessment is presented in Appendix 2. A JBI score higher than 70% was classified as having a high quality, those with a score between 50% and 70% as having a medium quality and those with a score less than 50% as having a low quality (Pimsen et al, 2022).…”

Section: Critical Appraisalmentioning

confidence: 99%

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The effectiveness of nurse‐led care in supporting self‐management in patients with cancer: A systematic review

Lanfear,

Harding

2023

Journal of Clinical Nursing

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Aims and objectivesTo determine the impact of nurse‐led follow‐up care supporting self‐management of people who have had or have cancer.BackgroundCancer care is evolving towards enabling people to self‐manage the impact of cancer, treatment and overall care on their quality of life (QoL), self‐efficacy and distress.DesignA systematic review following Joanna Briggs Institution (JBI) guidance and reported in accordance with the PRISMA statement was undertaken.MethodsFour databases were searched, OVID Medline, CINAHL, PsychINFO and Embase. Quantitative randomised control trials with people who have or have had cancer accessing nurse‐led care or nurse‐led intervention, undertaken within secondary care were included. Narrative synthesis was undertaken due to heterogeneity of measures used and time points of assessment.ResultsSeven papers were included in the final review, all meeting moderate to high‐quality appraisal. Only one study found an impact of nurse‐led care on all three factors under investigation, with a further two studies finding an effect on distress. The remaining studies did not find an impact of the intervention.ConclusionClinical Nurse Specialists are well placed to provide follow‐up care for people with cancer, but in relation to QoL, self‐efficacy and distress, there is limited evidence of effectiveness of nurse‐led interventions.Public or patient contributionThis systematic review did not have any public or patient contribution.Relevance to clinical practiceCancer care is moving to a chronic care, self‐management model. Clinical nurse specialists are well placed to innovate interventions that assist people with cancer to self‐manage.

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Section: Critical Appraisalmentioning

confidence: 99%

“…Table 1 presents the study design of each of the retained articles. The quality of the studies ranged from 53% to 84%, which could be described as moderate to high (Pimsen et al, 2022).…”

Section: Study Characteristicsmentioning

confidence: 99%

The effectiveness of nurse‐led care in supporting self‐management in patients with cancer: A systematic review

Lanfear,

Harding

2023

Journal of Clinical Nursing

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“…Additionally, it helps promote goal-concordant, end-of-life care through advance care planning (ACP) . Although palliative care interventions mainly target the nonsurgical population, there is limited evidence regarding the benefits of these interventions (eg, facilitating decision-making and reducing health care resource utilization) for surgical candidates . Formalized incorporation of ACP in surgical patients remains historically low.…”

Section: Introductionmentioning

confidence: 99%

Early Integrated Palliative Care Within a Surgical Oncology Clinic

Bansal,

Kim,

Reddy

et al. 2023

JAMA Netw Open

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ImportanceAdvance directive (AD) designation is an important component of advance care planning (ACP) that helps align care with patient goals. However, it is underutilized in high-risk surgical patients with cancer, and multiple barriers contribute to the low AD designation rates in this population.ObjectiveTo assess the association of early palliative care integration with changes in AD designation among patients with cancer who underwent surgery.Design, Setting, and ParticipantsThis cohort study was a retrospective analysis of a prospectively maintained registry of adult patients who underwent elective surgery for advanced abdominal and soft tissue malignant tumors at a surgical oncology clinic in a comprehensive cancer center with expertise in regional therapeutics between June 2016 and May 2022, with a median (IQR) postoperative follow-up duration of 27 (15-43) months. Data analysis was conducted from December 2022 to April 2023.ExposureIntegration of ACP recommendations and early palliative care consultations into the surgical workflow in 2020 using electronic health records (EHR), preoperative checklists, and resident education.Main Outcomes and MeasuresThe primary outcomes were AD designation and documentation. Multivariable logistic regression was performed to assess factors associated with AD designation and documentation.ResultsAmong the 326 patients (median [IQR] age 59 [51-67] years; 189 female patients [58.0%]; 243 non-Hispanic White patients [77.9%]) who underwent surgery, 254 patients (77.9%) designated ADs. The designation rate increased from 72.0% (131 of 182 patients) before workflow integration to 85.4% (123 of 144 patients) after workflow integration in 2020 (P = .004). The AD documentation rate did not increase significantly after workflow integration in 2020 (48.9% [89 of 182] ADs documented vs 56.3% [81 of 144] ADs documented; P = .19). AD designation was associated with palliative care consultation (odds ratio [OR], 41.48; 95% CI, 9.59-179.43; P &lt; .001), palliative-intent treatment (OR, 5.12; 95% CI, 1.32-19.89; P = .02), highest age quartile (OR, 3.79; 95% CI, 1.32-10.89; P = .01), and workflow integration (OR, 2.05; 95% CI, 1.01-4.18; P = .048). Patients who self-identified as a race or ethnicity other than non-Hispanic White were less likely to have designated ADs (OR, 0.36; 95% CI, 0.17-0.76; P = .008). AD documentation was associated with palliative care consulation (OR, 4.17; 95% CI, 2.57- 6.77; P &lt; .001) and the highest age quartile (OR, 2.41; 95% CI, 1.21-4.79; P = .01).Conclusions and RelevanceAn integrated ACP initiative was associated with increased AD designation rates among patients with advanced cancer who underwent surgery. These findings demonstrate the feasibility and importance of modifying clinical pathways, integrating EHR-based interventions, and cohabiting palliative care physicians in the surgical workflow for patients with advanced care.

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“…Research examining ACP interventions have revealed significant variability in the use of standardized versus non‐standardized outcome measures, making evaluation of ACP effectiveness challenging 7,11–20 . Most recently, a scoping review of ACP randomized controlled trials (RCTs) mapped out outcome measures using the standardized ACP Outcome Framework 21 ; which categorizes outcome measures as either process (e.g., readiness), action (e.g., communication), healthcare (e.g., healthcare utilization), or quality of care (e.g., satisfaction).…”

Section: Introductionmentioning

confidence: 99%

“…9,10 Research examining ACP interventions have revealed significant variability in the use of standardized versus nonstandardized outcome measures, making evaluation of ACP effectiveness challenging. 7,[11][12][13][14][15][16][17][18][19][20] Most recently, a scoping review of ACP randomized controlled trials (RCTs) mapped out outcome measures using the standardized ACP Outcome Framework 21 ; which categorizes outcome measures as either process (e.g., readiness), action (e.g., communication), healthcare (e.g., healthcare utilization), or quality of care (e.g., satisfaction). This review showed that most high-quality ACP intervention trials had a positive impact on process and action outcome measures with mixed results on quality of care (such as goal concordance) and healthcare (such as hospitalization) outcome measures.…”

Section: Introductionmentioning

confidence: 99%

Evaluating the pragmatic characteristics of advance care planning outcome measures in dementia clinical trials: A scoping review

Gabbard,

Carpenter,

Ernecoff

et al. 2023

J American Geriatrics Society

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BackgroundAdvance care planning (ACP) is a process that involves discussing a person's goals, values, and preferences; it is particularly important for persons living with dementia (PLWD) given that dementia is incurable and progressive. To ensure results that will impact real‐world practices, ACP outcome measures must be psychometrically strong, meaningful to key partners, and pragmatic to collect. Therefore, we conducted a scoping review of outcome measures utilized in ACP randomized controlled clinical trials (RCTs) enrolling PLWD or their care partners and evaluated their pragmatic characteristics.MethodsWe searched MEDLINE/PubMed, EMBASE, CINAHL, PsycINFO, and Web of Science for peer‐reviewed ACP RCTs enrolling PLWD or their care partners from 2011 to 2021. We abstracted characteristics of primary and secondary outcome measures, including pragmatic characteristics using an adapted Psychometric and Pragmatic Evidence Rating Scale and ACP outcome domains using the standardized ACP Outcome Framework (i.e., process, action, healthcare, or quality of care).ResultsWe included 21 ACP RCTs. Trials included 103 outcome measures (39 primary and 64 secondary), of which 11% measured process, 14% measured action, 49% measured healthcare, and 26% measured quality of care. Twenty‐four (23%) outcome measures were highly pragmatic, the majority of which (67%) reflected healthcare outcome measures. Sixty‐one (59%) outcomes were assessed as highly relevant to PLWD or their care partners. Only 20% (n = 21) of outcome measures were embedded into clinical practice. Most (62%) RCTs were conducted in nursing homes, and 33% were focused PLWD with advanced stage disease.ConclusionsIn RCTs testing ACP interventions to support PLWD, only 23% of outcome measures were highly pragmatic, and most of these measured healthcare utilizations. Outcome assessments were rarely integrated into the EHR during routine clinical care. New outcome measures that address the lived experience of PLWD and their care partners plus have high pragmatic characteristics are needed for embedded pragmatic clinical trials.

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The Effect of Advance Care Planning Intervention on Hospitalization Among Nursing Home Residents: A Systematic Review and Meta-Analysis

Cited by 32 publications

References 48 publications

The effectiveness of nurse‐led care in supporting self‐management in patients with cancer: A systematic review

The effectiveness of nurse‐led care in supporting self‐management in patients with cancer: A systematic review

Early Integrated Palliative Care Within a Surgical Oncology Clinic

Evaluating the pragmatic characteristics of advance care planning outcome measures in dementia clinical trials: A scoping review

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