Summary of characteristics of included papers
| Study | Design | Aim | Sample | Weight of evidence* |
| Barnato et al 38 | Observational: cross-sectional | Explore uptake of the ACP billing code in the USA | 113 612 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) |
| Black41 | Observational: cross-sectional | Describe social workers' AD communications with hospitalised older patients | 29 social workers in 6 US hospitals. | Low (L, L, L) |
| Black34 | Qualitative: focus groups | Compare nurses' and social workers' roles in AD communication with older patients | 6 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 Emmet35 | Observational: cross-sectional | Describe nurses' communication about ADs with hospitalised older patients | 74 nurses in 2 US hospitals working primarily with geriatric patients. | Low (L, L, L) |
| Bristowe et al 29 | Interventional: non-randomised trial | Compare experience of care when supported by an intervention including ACP with standard care | Next 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 al 39 | Interventional: interrupted time series | Design, implement and evaluate an ACP programme, focusing on hospitalised older patients | Inpatients 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 al 30 | Observational: cross-sectional | Assess 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, 201028 | Interventional: RCT | Assess whether ACP with older inpatients improves outcomes | 309 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 al 40 | Observational: cross-sectional | Assess feasibility and acceptability of ACP in older non-English-speaking patients | 112 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 al 33 | Qualitative: semi-structured interviews | Determine the barriers and facilitators to ACP engagement in hospital | 17 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 al 36 | Observational: cross-sectional | Determine opinions of hospital doctors and nurses on ADs | 283 hospital physicians and nurses in Spain. | Low (M, L, L) |
| Schiff et al 31 | Observational: cross-sectional | Determine older inpatients’ knowledge about ADs | 74 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 al 32 | Observational: cross-sectional | Evaluate an ACP document for older inpatients | 99 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 al 37 | Interventional: before and after study | To develop, implement and assess an ACP programme in an Australian hospital | 381 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.