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State of advance care planning research: A descriptive overview of systematic reviews

Published online by Cambridge University Press:  30 July 2018

Geronimo Jimenez ,
Woan Shin Tan ,
Amrit K. Virk ,
Chan Kee Low ,
Josip Car  and
Andy Hau Yan Ho
Geronimo Jimenez*
Affiliation:
Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
Woan Shin Tan
Affiliation:
Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore NTU Institute of Health Technologies (HealthTech), Interdisciplinary Graduate School, Nanyang Technological University, Singapore Health Services and Outcomes Research Department, National Healthcare Group, Singapore
Amrit K. Virk
Affiliation:
Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
Chan Kee Low
Affiliation:
Economics Programme, School of Social Sciences, Nanyang Technology University, Singapore
Josip Car
Affiliation:
Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, United Kingdom
Andy Hau Yan Ho
Affiliation:
Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore Psychology Programme, School of Social Sciences, Nanyang Technological University, Singapore Palliative Care Centre for Excellence in Research and Education, Singapore
*
Author for correspondence: Geronimo Jimenez, 11 Mandalay Road, Level 18 Clinical Sciences Building, Lee Kong Chian School of Medicine, Novena Campus, Nanyang Technological University, Singapore 308232. E-mail: [email protected]
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Abstract

Objective

To provide an overview of the current state of research of advance care planning (ACP), highlighting most studied topics, publication time, quality of studies and reported outcomes, and to identify gaps to improve ACP receptivity, utilization, implementation, and outcomes.

Method

Cochrane methodology for conducting overviews of systematic reviews. Study quality was assessed using a modified version of the Assessing the Methodological Quality of Systematic Reviews tool. The following databases were searched from inception to April 2017: MEDLINE, EBM Reviews, Cochrane Reviews, CINAHL, Global Health, PsycINFO, and EMBASE. Searches were supplemented with gray literature and manual searches.

Result

Eighty systematic reviews, covering 1,662 single articles, show that ACP-related research focuses on nine main topics: (1) ACP as part of end-of-life or palliative care interventions, (2) care decision-making; (3) communication strategies; (4) factors influencing ACP implementation; (5) ACP for specific patient groups, (6) ACP effectiveness; (7) ACP experiences; (8) ACP cost; and (9) ACP outcome measures. The majority of this research was published since 2014, its quality ranges from moderate to low, and reports on documentation, concordance, preferences, and resource utilization outcomes.

Significance of results

Despite the surge of ACP research, there are major knowledge gaps about ACP initiation, timeliness, optimal content, and impact because of the low quality and fragmentation of the available evidence. Research has mostly focused on discrete aspects within ACP instead of using a holistic evaluative approach that takes into account its intricate working mechanisms, the effects of systems and contexts, and the impacts on multilevel stakeholders. Higher quality studies and innovative interventions are needed to develop effective ACP programs and address research gaps.

Keywords

Advance care planningEnd-of-life carePalliative careOverviewSystematic reviews
Type
Review Article
Information
Palliative & Supportive Care , Volume 17 , Issue 2 , April 2019 , pp. 234 - 244
Copyright
Copyright © Cambridge University Press 2018 

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