Advance Care Planning in palliative care: A systematic literature review of the contextual factors influencing its uptake 2008–2012

1. Allison Lovell1,2 Patsy Yates3

1. ¹Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
2. ²Specialist Palliative Care Service, Division of Internal Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
3. ³Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia

1. Allison Lovell, Faculty of Health, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, QLD 4059, Australia. Email: allison.lovell@health.qld.gov.au

Abstract

Background: Advance Care Planning is an iterative process of discussion, decision-making and documentation about end-of-life care. Advance Care Planning is highly relevant in palliative care due to intersecting clinical needs. To enhance the implementation of Advance Care Planning, the contextual factors influencing its uptake need to be better understood.

Aim: To identify the contextual factors influencing the uptake of Advance Care Planning in palliative care as published between January 2008 and December 2012.

Methods: Databases were systematically searched for studies about Advance Care Planning in palliative care published between January 2008 and December 2012. This yielded 27 eligible studies, which were appraised using National Institute of Health and Care Excellence Quality Appraisal Checklists. Iterative thematic synthesis was used to group results.

Results: Factors associated with greater uptake included older age, a college degree, a diagnosis of cancer, greater functional impairment, being white, greater understanding of poor prognosis and receiving or working in specialist palliative care. Barriers included having non-malignant diagnoses, having dependent children, being African American, and uncertainty about Advance Care Planning and its legal status. Individuals’ previous illness experiences, preferences and attitudes also influenced their participation. 

Conclusion: Factors influencing the uptake of Advance Care Planning in palliative care are complex and multifaceted reflecting the diverse and often competing needs of patients, health professionals, legislature and health systems. Large population-based studies of palliative care patients are required to develop the sound theoretical and empirical foundation needed to improve uptake of Advance Care Planning in this setting.