Background There is a substantial evidence for the added value of advance care planning (ACP) programs compared to the use of advance directive (AD) forms. However, little is known about which components of ACP are the most important or effective.
Aim To identify the core structural components of ACP interventions.
Methods Electronic databases were searched for systematic reviews focused on the effectiveness of ACP. From these reviews, trials involving ACP were identified (trials involving only AD were excluded). 21 different ACP programs were scrutinised for the following elements: timing, content, setting, facilitator, and outcomes.
Results Eleven ACP programs included only one interventional contact with subjects, 15 programs included less than 4 sessions. Seven interventions included completion of an AD. In most cases, nurses were the facilitators of ACP discussions (n = 13), followed by social workers (n = 7). Only 5 studies evaluated the impact of the ACP on end-of-life outcomes. Completion of AD forms was the most commonly measured outcome (n = 12).
Discussion Most studies we found did not test ACP as a series of conversations that occur over time, as would be suggested by the theoretical model of ACP. As such the current literature does not yet appropriately evaluate the overall effectiveness of ACP as an ongoing dialogue. There are also few studies that examine concordance of ACP to treatments received.
Conclusion More longitudinal studies are needed to evaluate the impact of ACP. Consensus about the desired primary outcomes of ACP is needed and should be reflected in future studies in this field.
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