Table 3

Summary of characteristics of included papers

StudyDesignAimSampleWeight of evidence*
Barnato et al38Observational: cross-sectionalExplore uptake of the ACP billing code in the USA113 612 inpatients aged >65 years in 250 US hospitals. Mean age 78 years, diagnosis: 3% cancer, 23% organ failure, 4% dementia, 70% other; 49% requiring home healthcare, care home or inpatient care at discharge or deceased.High (H, H, H)
Black41Observational: cross-sectionalDescribe social workers' AD communications with hospitalised older patients29 social workers in 6 US hospitals.Low (L, L, L)
Black34Qualitative: focus groupsCompare nurses' and social workers' roles in AD communication with older patients6 nurses and 5 social workers in one US hospital selected from practice areas with high volumes of older patients.Low (L, M, L)
Black and Emmet35Observational: cross-sectionalDescribe nurses' communication about ADs with hospitalised older patients74 nurses in 2 US hospitals working primarily with geriatric patients.Low (L, L, L)
Bristowe et al29Interventional: non-randomised trialCompare experience of care when supported by an intervention including ACP with standard careNext of kin of 95 medical inpatients in UK hospitals who died <100 days after discharge. Mean age 77 years, 31% cancer diagnosis, 69% non-cancer, no information regarding need for help with personal care.Medium (L, M, M)
Cantillo et al39Interventional: interrupted time seriesDesign, implement and evaluate an ACP programme, focusing on hospitalised older patientsInpatients aged >80 years with 2 admissions in the last 6 months, or aged >90 years, or discharged to hospice services in 4 hospitals in Hawai'i. No further information on sample characteristics.Low (M, L, L)
Cheang et al30Observational: cross-sectionalAssess prevalence of ACP; to explore the feasibility of an ACP screening interview.100 consecutive inpatients aged >80 years at an Australian hospital. Mean age 87 years, diagnosis: 3% cancer, 3% organ failure, 6% stroke, 88% other diagnoses; 67% requiring care home or inpatient care at discharge.Medium (M, H, M)
Detering, 201028Interventional: RCTAssess whether ACP with older inpatients improves outcomes309 medical inpatients aged >80 years at an Australian hospital. Median age 84–85 years, admission diagnosis 32%–34% cardiac, 30%–33% respiratory, 8%–14% falls, 24%–25% other. No information regarding need for help with personal care.High (H, H, M)
Detering et al40Observational: cross-sectionalAssess feasibility and acceptability of ACP in older non-English-speaking patients112 inpatients aged >65 years at a teaching hospital in Australia. Median age 81–82 years, diagnosis 35%–39% cardiopulmonary, 17%–24% cancer, 8%–13% neurological, 29%–35% other. No information regarding need for help with personal care.Low (M, L, L)
Peck et al33Qualitative: semi-structured interviewsDetermine the barriers and facilitators to ACP engagement in hospital17 inpatients: 2 aged >85 with an acute medical problem, 15 whose doctor would not be surprised if they died in <6 months in one Canadian hospital. Mean age 75 years. No information on diagnosis nor need for help with personal care.High (H, H, M)
Pérez et al36Observational: cross-sectionalDetermine opinions of hospital doctors and nurses on ADs283 hospital physicians and nurses in Spain.Low (M, L, L)
Schiff et al31Observational: cross-sectionalDetermine older inpatients’ knowledge about ADs74 medical inpatients aged >65 years at two UK hospitals. Mean age 81 years. No information on diagnosis; 50% ‘received home help’, no other information on need for help with personal care.Medium (M, M, M)
Schiff et al32Observational: cross-sectionalEvaluate an ACP document for older inpatients99 inpatients aged >60 years on geriatric wards in two UK hospitals. Mean age 81 years. No information on diagnosis nor need for help with personal care.Medium (M, M, M)
Scott et al37Interventional: before and after studyTo develop, implement and assess an ACP programme in an Australian hospital381 medical inpatients with estimated life expectancy of <12 months. Mean age 78 years, mean number of comorbidities 3.9, 37% living in care home on admission.Medium (M, M, H)

  • *Weight of evidence D (weight of evidence A, weight of evidence B, weight of evidence C, where L=low, M=medium, H=high).

  • ACP, advance care planning; AD, Advance Directive; RCT, randomised controlled trial.