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Advance care plans for vulnerable and disadvantaged adults: systematic review and narrative synthesis
  1. Samantha Jane Brean1,2,
  2. Katrina Recoche2,
  3. Leeroy William3,4,
  4. Ali Lakhani5,
  5. Yaping Zhong2 and
  6. Kaori Shimoinaba2
  1. 1 Advance Care Planning, Eastern Health, Wantirna, Victoria, Australia
  2. 2 Monash University, School of Nursing and Midwifery Peninsula Campus, Frankston, Victoria, Australia
  3. 3 Supportive and Palliative Care Service, Eastern Health, Wantirna, Victoria, Australia
  4. 4 Monash University, Eastern Health Clinical School, Box Hill, Victoria, Australia
  5. 5 La Trobe University, School of Psychology and Public Health, Melbourne, Victoria, Australia
  1. Correspondence to Samantha Jane Brean, Advance Care Planning, Eastern Health, Wantirna, VIC 3128, Australia; sam.brean{at}


Background Evidence suggests that there is a gap in advance care planning (ACP) completion between vulnerable and disadvantaged populations compared with the general population. This review seeks to identify tools, guidelines or frameworks that have been used to support ACP interventions with vulnerable and disadvantaged adult populations as well as their experiences and outcomes with them. The findings will inform practice in ACP programmes.

Methods A systematic search of six databases from 1 January 2010 to 30 March 2022 was conducted to identify original peer-reviewed research that used ACP interventions via tools, guidelines or frameworks with vulnerable and disadvantaged adult populations and reported qualitative findings. A narrative synthesis was conducted.

Results Eighteen studies met the inclusion criteria. Relatives, caregivers or substitute decision-makers were included in eight studies. Settings: hospital outpatient clinics (N=7), community settings (N=7), nursing homes (N=2), prison (N=1) and hospital (N=1). A variety of ACP tools, guidelines or frameworks were identified; however, the facilitator’s skills and approach in delivering the intervention appeared to be as important as the intervention itself. Participants indicated mixed experiences, some positive, some negative and four themes emerged: uncertainty, trust, culture and decision-making behaviour. The most common descriptors relating to these themes were prognosis uncertainty, poor end-of-life communication and the importance of building trust.

Conclusion The findings indicate that ACP communication could be improved. ACP conversations should incorporate a holistic and personalised approach to optimise efficacy. Facilitators should be equipped with the necessary skills, tools and information needed to assist ACP decision-making.

  • Communication
  • Quality of life

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Contributors KS, KR and LW supervised the study. SJB, KS, KR and LW were responsible for planning the study, design, article screening and quality assessment. AL guided research methodology. YZ: article screening. SB drafted manuscript. KS, KR, LW and AL reviewed draft manuscript and made critical revisions. SJB is the guarantor and is responsible for the overall content.

  • 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.