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Cited by 71Palliative Care and End-of-Life IssuesPalliative and Oncologic CareEthics and bioethics in healthcare

The DOI matches its Crossref record; 8 of the 8 references it cites were found in a registry or an index.

Advance Care Planning With Patients Who Have End-Stage Kidney Disease: A Systematic Realist Review

Open access
O'Halloran, Peter, Noble, Helen, Norwood, Kelly, Maxwell, Peter, Shields, Joanne, Fogarty, Damian, Murtagh, Fliss, Morton, Rachael, Brazil, Kevin·2018·Journal of Pain and Symptom Management
DOI 10.1016/j.jpainsymman.2018.07.008PMC PMC6203056
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Abstract

CONTEXT: Patients with end-stage kidney disease have a high mortality rate and disease burden. Despite this, many do not speak with health care professionals about end-of-life issues. Advance care planning is recommended in this context but is complex and challenging. We carried out a realist review to identify factors affecting its implementation. OBJECTIVES: The objectives of this study are 1) to identify implementation theories; 2) to identify factors that help or hinder implementation; and 3) to develop theory on how the intervention may work. METHODS: We carried out a systematic realist review, searching seven electronic databases: Medline, Embase, CINAHL, PsycINFO, Cochrane Library, Google Scholar, and ScienceDirect. RESULTS: Sixty-two papers were included in the review. CONCLUSION: We identified two intervention stages-1) training for health care professionals that addresses concerns, optimizes skills, and clarifies processes and 2) use of documentation and processes that are simple, individually tailored, culturally appropriate, and involve surrogates. These processes work as patients develop trust in professionals, participate in discussions, and clarify values and beliefs about their condition. This leads to greater congruence between patients and surrogates; increased quality of communication between patients and professionals; and increased completion of advance directives. Advance care planning is hindered by lack of training; administrative complexities; pressures of routine care; patients overestimating life expectancy; and when patients, family, and/or clinical staff are reluctant to initiate discussions. It is more likely to succeed where organizations treat it as core business; when the process is culturally appropriate and takes account of patient perceptions; and when patients are willing to consider death and dying with suitably trained staff.

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Crossref · 10.1016/j.jpainsymman.2018.07.008

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  • The results of 21 studies (RCT, n = 3) included in a systematic review suggested that communication skills training interventions increase comfort, self-efficacy, and preparedness of healthcare professionals in the delivery of end-of-life care.

    “The results of 21 studies (RCT, n = 3) included in a systematic review suggested that communication skills training interventions increase comfort, selfefficacy, and preparedness of healthcare professionals in the delivery of end-of-life care. 37”

    From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [37]

    Split into 2 atoms — 0 confirmed, 1 partially supported, 1 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

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  • Advance care planning discussions with a trained nurse facilitator, structured nurse-led advance care planning discussions with long-term care residents of a nursing home and their proxies, and a physician and clinical nurse specialist team processing medical information of the primary physician all improved consensus about care between patients, their families and healthcare professionals.

    “Advance care planning discussions with a trained nurse facilitator, structured nurse-led advance care planning discussions with longterm care residents of a nursing home and their proxies, and a physician and clinical nurse specialist team processing medical information of the primary physician all improved the consensus about care between patients, their families and the healthcare professionals.”

    From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [37]

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

  • Evidence from systematic reviews suggests that advance care planning is associated with improvements in symptom control and quality of life.

    “Evidence from systematic reviews suggests that advance care planning is associated with improvements in symptom control and quality of life. 9,30,31,37,38,50,59”

    From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [37]

    The Introduction says advance care planning is associated with improved quality of life in the general population. The Results section on intervention outcomes and the Discussion do not report improved symptom control; the Discussion cautions that outcomes beyond preferences and communication remain unsupported or equivocal. Page numbers were not available in our copy. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Family support interventions may help reduce psychological impacts on family members, as suggested by four systematic reviews and two recent studies.

    “Family support interventions may help to reduce these psychological impacts, as suggested by four systematic reviews, 37,71,72,83 and two recent studies. 84,85”

    From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [37]

    The Results (Program Theories; page unavailable) say that involving surrogates in advance care planning may prepare them for the emotional burden of decision-making. The Results (Outcomes of Advance Care Planning Interventions; page unavailable) also report improved surrogate decision-making confidence. The review does not establish that family support interventions reduce psychological impacts on family members more broadly. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • The use of structured communication tools may help improve communication with families, as suggested by two systematic reviews.

    “The use of structured communication tools may help to improve communication with families, as suggested by two systematic reviews. 37,44”

    From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [37]

    The Theory Synthesis (page unavailable) says advance care planning interventions increased patient–surrogate agreement and the quality of communication between patients and clinical staff. The Discussion (page unavailable) describes guided interactions involving patients, surrogates and trained facilitators, but the review does not specifically report improved communication with families as an outcome of structured communication tools. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

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Citations

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Metadata

Authors
O'Halloran, P., Noble, H., Norwood, K., Maxwell, P., Shields, J., Fogarty, D., Murtagh, F., Morton, R., & Brazil, K.
Affiliations
  • Queen's University Belfast (GB)
  • University of Ulster (GB)
  • Belfast City Hospital (GB)
  • University of Hull (GB)
  • The University of Sydney (AU)
ORCID
Venue
Journal of Pain and Symptom Management
Publisher
Elsevier BV
Published
2018-11
Volume
56
Issue
5
Pages
795-807.e18
ISSN
0885-3924 (ISSN-L)
DOI
10.1016/j.jpainsymman.2018.07.008
PMC
PMC6203056
OpenAlex
W2883821521
Cited by
71
References
8
Citations by year
2026: 5 · 2025: 6 · 2024: 10 · 2023: 7 · 2022: 10 · 2021: 21 · 2020: 8 · 2019: 4
FWCI
1.50
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Pain and Symptom Management (publishedVersion, cc-by-nc-nd)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Repository@Hull (Worktribe) (University of Hull) (publishedVersion, other-oa)
  • Ulster University Research Portal (Ulster University) (publishedVersion, cc-by-nc-nd)
  • Repository@Hull (Worktribe) (University of Hull) (submittedVersion, cc-by-nc-nd)
  • Research Portal (Queen's University Belfast) (submittedVersion, cc-by-nc-nd)
  • The Sydney eScholarship Repository (The University of Sydney) (submittedVersion, cc-by-nc-nd)
Funders
  • Public Health Agency (STL/4760/13)
  • Medical Research Council (MC_PC_15025)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
Keywords
advance care planning, end-stage renal disease, end-of-life care, health professions education, advance directives, surrogate decision-making, patient-professional communication, implementation barriers, cultural appropriateness, patient trust, patient values and beliefs
MeSH terms
Humans, Kidney Failure, Chronic, Advance Care Planning

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