Efficacy of Advance Care Planning:

 A Systematic Review and Meta-Analysis

• Carmen H.M. Houben, MSc
,
• Martijn A. Spruit, PhD
,
• Miriam T.J. Groenen, MSc
,
• Emiel F.M. Wouters, PhD, MD
,
• Daisy J.A. Janssen, PhD, MD

published online 04 March 2014.

JAMDA
Volume 15, Issue 7 , Pages 477-489, July 2014Abstract 

Objective

To systematically review the efficacy of advance care planning (ACP) interventions in different adult patient populations.

Study Selection

Randomized controlled trials that describe original data on the efficacy of ACP interventions in adult populations and were written in English.

Data Extraction and Synthesis

Fifty-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 Measures

Primary 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.

Results

Interventions 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.

Conclusions

ACP 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.

Keywords: Advance care planning, end-of-life care, communication, advance directives