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Dyadic advance care planning: systematic review of patient–caregiver interventions and effects
  1. Xiaohang Liu1,
  2. Tongyao Wang1,
  3. Denise Shuk Ting Cheung1,
  4. Pui Hing Chau1,
  5. Mu-Hsing Ho1,
  6. Yuanxia Han2 and
  7. Chia-Chin Lin1
  1. 1 School of Nuring, The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong
  2. 2 Department of Pancreatic Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
  1. Correspondence to Professor Chia-Chin Lin, School of Nursing, The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong; cclin{at}hku.hk

Abstract

Introduction Family caregiver’s involvement in advance care planning (ACP) is essential to provide high-quality end-of-life (EOL) care and to ease the surrogate decision-making burden. However, no systematic review has focused on existing ACP interventions involving patients and their families.

Aim To systematically summarise current ACP interventions involving patients and their families.

Methods Five English and two Chinese databases were searched from inception to September 2022. The eligible studies were experimental studies describing original data. The Joanna Briggs Institute critical appraisal tools assessed the methodological quality. Narrative synthesis was conducted for data analysis.

Results In total, twenty-eight articles were included. Fifteen studies were randomised controlled trials, and the rest 13 studies were quasi-experimental studies. The data synthesis identified: (1) Key intervention components: strategies to promote ACP, ACP discussion and follow-up, as well as the role of family caregivers; (2) Effects on intended outcomes: interventions have shown benefit on completion of ACP actions, while inconsistent findings were found on the process outcomes and quality of EOL care. In addition, a logic model for patient–caregiver dyadic ACP was created, and the underlying mechanisms of action included well-preparation, open discussion and adequate support for plan/action.

Conclusions This review provides comprehensive evidence about patient–caregiver dyadic ACP, a promising intervention to better prepare for EOL communication and decision-making. A logic model has been mapped to give a preliminary indication for future implementation. More empirical studies are needed to improve this model and culturally adapt it in a real-world setting.

  • End of life care
  • Communication

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

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Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

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Footnotes

  • X @muhsingho

  • Contributors XL: guarantor, conceptualisation, methodology, data selection and extraction, critical appraisal, formal analysis, writing—original draft. TW: data selection and extraction, critical appraisal, formal analysis, writing—review and editing. DSTC: methodology, supervision, writing—review and editing. PHC: supervision, writing—review and editing. M-HH: writing—review and editing. YH: conceptualisation, writing—review and editing. C-CL: conceptualisation, methodology, supervision, writing —review and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.