Journal of the American Medical Directors Association
Review ArticleThe Effects of Advance Care Planning Interventions on Nursing Home Residents: A Systematic Review
Section snippets
Design
This systematic review has been prospectively registered with PROSPERO.36
Search Strategy
In April 2015, a comprehensive literature search was conducted using the following 4 electronic databases, Embase, Medline, PsychINFO, and CINAHL, with no limits on year or language. The search strategy is available for review in Figure 1. The search yielded 4654 titles. There were no restrictions by study design at this time so as to allow identification of all studies related to the question. Hand-searching of citations
Study Characteristics
Seven of the studies took place in the USA, 1 took place in Australia, 1 in Hong Kong, 1 in Canada, 1 in the United Kingdom, 1 in Singapore, and in The Netherlands. The intervention in 5 studies was an educational program. For 2 of these, the ACP education was provided just to healthcare staff,39, 40 whereas in the other 3, education was provided to healthcare staff, residents, and families.28, 29, 41 Five studies involved introduction or evaluation of a new ACP form in the facility.32, 42, 43,
Interventions
Findings from this review show beneficial effects for ACP interventions in the nursing home population, but the evidence supporting the findings is of generally low quality. The variability in the interventions was considerable, but over 75% could be classified broadly into 2 categories: (1) educational programs; or (2) introduction and evaluation of a new ACP in the facilities. Five of the 13 studies took either an educational approach for staff or an educational approach for staff, families,
Conclusions
The data on ACP interventions shows beneficial effects in nursing home populations; the most important of which include actions being consistent with the person's wishes and avoidance of unwanted hospitalization and life-sustaining treatments. The available evidence is generally not of high quality. Most studies in the area are of retrospective designs and, as a consequence, 44 such studies were excluded from this review.
ACP is important for frail older people where the possibility of
Key Points
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The nursing home population has unique characteristics for ACP.
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ACP has beneficial effects for the nursing home population.
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ACP leads to actions being more consistent with resident's wishes.
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ACP decreases unwanted hospitalization and use of life-sustaining treatments, and increases probability of dying in the nursing home.
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ACP is important for decreasing unwanted medical interventions at end-of-life
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ACP can decrease healthcare costs.
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The effects found are mainly from pooled low quality studies
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The authors declare no conflicts of interest.