Background Advance care planning (ACP) is a process where patients express their wishes regarding their future healthcare. Its importance has been increasingly recognised in the past decade. As increasing numbers of elderly people are living in care homes, the aim of this review was to identify the most effective ACP interventions to train/educate all levels of healthcare professionals working in care homes.
Design A systematic review. Two independent reviewers undertook screening, data extraction and quality assessment.
Data sources Searched from inception to June 2018: Ovid Medline, Ovid Medline in process, Ovid Embase, Cochrane Central Register of Controlled Trials, EBSCO Cinahl and Ovid PsycINFO.
Results Six studies were included: three before and after studies, one cluster randomised controlled trial (RCT), one non-blinded RCT and one qualitative study. Five studies reported on ACP documentation, three on impact on ACP practice and three studies on healthcare-related outcomes. All quantitative studies reported an improvement in outcomes. In the three studies reporting on health-related outcomes, one showed significant reductions in hospitalisation rate, days and healthcare costs; one reported significant reductions in hospital deaths; and the third showed reductions in hospital days and deaths. A meta-analysis could not be performed due to the heterogeneity of the outcome measures. The included qualitative study highlighted perceived challenges to implementing an educational programme in the care home setting.
Conclusion There is limited evidence for the effectiveness of ACP training for care home workers. More well-designed studies are needed.
Trial registration number CRD42016042385 .
- clinical decisions
- advance care planning
- terminal care
- nursing homes
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Collaborators Annmarie Nelson.
Contributors All persons who meet authorship criteria are listed as authors, and all authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing or revision of the manuscript. Furthermore, each author certifies that this material or similar material has not been and will not be submitted to or published in any other publication before its appearance in the BMJ Supportive and Palliative Care. Conception or design of the work: AG. Collection: MM. Analysis/interpretation: AG, SN. Drafting the article: AG. Critical revision of the article: SN, MM. Final approval of the version to be published: AG, SN, MM.
Funding The study was funded by the research team.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All additional data, including records of database searches, can be made available for review through the principal author (AG).