Efficacy of advance care planning: a systematic review and meta-analysis

Objective: To systematically review the efficacy of advance care planning (ACP) interventions in different adult patient populations.

Design: Systematic review and meta-analyses.

Data sources: Medline/PubMed, Cochrane Central Register of Controlled Trials (1966 to September 2013), and reference lists.

Study selection: Randomized controlled trials that describe original data on the efficacy of ACP interventions in adult populations and were written in English.

Data extraction and synthesis: Fifty-five studies were identified. Study details were recorded using a predefined data abstraction form. Methodological quality was assessed using the PEDro scale by 2 independent reviewers. Meta-analytic techniques were conducted using a random effects model. Analyses were stratified for type of intervention: 'advance directives' and 'communication.'

Main outcomes and measures: Primary outcome measures were completion of advance directives and occurrence of end-of-life discussions. Secondary outcomes were concordance between preferences for care and delivered care, knowledge of ACP, end-of-life care preferences, quality of communication, satisfaction with healthcare, decisional conflict, use of healthcare services, and symptoms.

Results: Interventions focusing on advance directives as well as interventions that also included communication about end-of-life care increased the completion of advance directives and the occurrence of end-of-life care discussions between patients and healthcare professionals. In addition, interventions that also included communication about ACP, improved concordance between preferences for care and delivered care and may improve other outcomes, such as quality of communication.

Conclusions: ACP interventions increase the completion of advance directives, occurrence of discussions about ACP, concordance between preferences for care and delivered care, and are likely to improve other outcomes for patients and their loved ones in different adult populations. Future studies are necessary to reveal the effective elements of ACP and should focus on the best way to implement structured ACP in standard care.