End-of-Life CareReview ArticleInterventions Guiding Advance Care Planning Conversations: A Systematic Review
Section snippets
Data Sources and Searches
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was used to structure the review process.9 A structured computerized literature search was performed in 4 databases: MEDLINE, Embase, PsycINFO, and CINAHL. The search strategy included terms describing the following domains: advance care planning, intervention, and communication (Table 1). Two reviewers (J.F., M.V.) independently screened all abstracts to select relevant papers. Disagreements were resolved
Results
The search yielded 15,745 unique hits. Eighty-two articles met the inclusion criteria (Figure 1) reporting on 34 unique ACP interventions. Sixty-one articles presented empirical data about 27 interventions.16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76 The remaining articles presented a description of
Findings
To our knowledge, this is the first systematic review evaluating the content, feasibility, and effectiveness of interventions based on a conversation guide to support health care professionals in ACP conversations. Thirty-four unique interventions were identified. Most interventions lacked a comprehensive theoretical underpinning. A thematic analysis of identified conversation guides revealed 4 subsequent phases of ACP conversations: preparation, initiation, exploration, and action. The
Conclusions
Scripted ACP conversation guides structure ACP discussions in 4 phases: preparation, initiation, exploration, and action. Exploration of patient's views on illness, living well, EOL issues, and decision making form the core part of ACP conversation guides. This exploration might support the professional to align medical care with patients' preferences. Research evaluating the relation between guided ACP conversations and preferences-concordant care is limited. Further research needs to reveal
Acknowledgments
We thank René Spijker for sharing his expertise in literature searches and for performing the electronic literature search. We thank Kyra Prinsze for her support in hand-searching the reference lists and double checking the quality of reporting assessment of qualitative studies.
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Cited by (0)
The study was sponsored by the Netherlands Organisation for Health Research and Development (ZonMw; Grant no. 844001206). The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
The authors declare no conflicts of interest.