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EP01.016 Community-based interventions for initiating early end-of-life conversations in nonterminally ill adults: a systematic review and meta-analysis
  1. Chun En Yau,
  2. Khi Yung Fong,
  3. Shuning Fu,
  4. Chen Ee Low,
  5. Noreen Chan,
  6. Miny Samuel and
  7. Mervyn Jun Rui Lim
  1. National University of Singapore, Singapore, Singapore


Background Conversations about end-of-life (EOL) care offer individuals opportunities to consider future treatment options in accordance with their values. While there are many reports focusing on community-based interventions for initiating early EOL planning behaviours in non-terminally ill adults, these interventions’ effects are poorly understood. This study provides a comprehensive review and analysis of community-based interventions for initiating early ACP conversations and increasing EOL planning behaviours.

Methods Medline, EMBASE, CENTRAL, PsycINFO and CINAHL were searched for relevant articles. for all two-armed studies, dichotomous data were analysed using meta-analysis of binary outcomes to calculate risk ratios (RR) and their 95% confidence interval (95%CI). for continuous measures, the standardized mean difference (SMD) and 95%CI were calculated with the inverse variance method. Quality of studies was appraised using the National Institute for Health and Care Excellence checklist and a thematic synthesis was conducted with the Theory of Planned Behaviour model.

Results 53 studies (34735 patients) that utilised interventions classified as workshops, 1-to-1 counselling, discussion groups, modified AD, complex methods, distribution of printed or online materials, were included in this study. In single-arm studies, pooled pre-post comparison of EOL test scores showed a significant benefit of EOL interventions with considerable heterogeneity (SMD=0.59, 95%CI=0.36–0.82, I2=78%, p<0.001). Within two-arm studies comparing EOL test scores, there was a trend towards overall benefit for EOL interventions (SMD=0.35, 95%CI= -0.01–0.72, I2=75%, p=0.060), although insignificant by a small margin. The comparison of EOL behaviours between both arms favoured EOL interventions over control (RR=2.40, 95%CI=1.27–4.53, I2=98%, p=0.007). In our thematic analysis, the interventions target different elements of behavioural change.

Conclusion This study reviews the most effective strategies in the community to initiate EOL conversations for non-terminally ill adults. These strategies modify different behavioural aspects of an individual’s intention to initiate EOL conversations and have proven to increase both EOL knowledge and behaviour.

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