Advance care planning: a systematic review of randomised controlled trials conducted with older adults
Open accessAbstract
Advance care planning (ACP), involving discussions between patients, families and healthcare professionals on future healthcare decisions, in advance of anticipated impairment in decision-making capacity, improves satisfaction and end-of-life care while respecting patient autonomy. It usually results in the creation of a written advanced care directive (ACD). This systematic review examines the impact of ACP on several outcomes (including symptom management, quality of care and healthcare utilisation) in older adults (>65years) across all healthcare settings. Nine randomised controlled trials (RCTs) were identified by searches of the CINAHL, PubMed and Cochrane databases. A total of 3646 older adults were included (range 72-88 years). Seven studies were conducted with community dwellers and the other two RCTs were conducted in nursing homes. Most studies did not implement a standardised ACD, or measure the impact on quality of end-of-life care or on the death and dying experience. All studies had some risk of bias, with most scoring poorly on the Oxford Quality Scale. While ACP interventions are well received by older adults and generally have positive effects on outcomes, this review highlights the need for well-designed RCTs that examine the economic impact of ACP and its effect on quality of care in nursing homes and other sectors.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The certainty of existing evidence has been judged most frequently as low to very low by authors of systematic reviews.
“Accordingly, the certainty of existing evidence has been judged most frequently as low to very low by authors of systematic reviews. 7 10,28,38,39,43,44,72”
From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [39]
Section 3.4 (page unavailable) reports that six of nine trials scored only 1 or 2 on the Oxford Quality Scale; the Discussion says all had some risk of bias. This supports concern about the quality of studies in this review, but the paper does not rate certainty of evidence as “low to very low” or establish how frequently other systematic reviews reached that judgment. (LLM, conf=0.85)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gotzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009) · BMJ · doi:10.1136/bmj.b2700 · Cited by 17,648 · see citing works
Detering, K. M., Hancock, A. D., Reade, M. C., & Silvester, W. (2010) · BMJ · doi:10.1136/bmj.c1345 · Cited by 2,332 · see citing works
Higgins, J. P., Deeks, J. J., & Altman, D. G. (2008) · Cochrane Handbook for Systematic Reviews of Interventions · doi:10.1002/9780470712184.ch16 · Cited by 475 · see citing works
Lund, S., Richardson, A., & May, C. (2015) · PLOS ONE · doi:10.1371/journal.pone.0116629 · Cited by 325 · see citing works
Flagged first, then by citations
Research works printed but not linked: 16
- J. Soong, A.J. Poots, S. Scott, et al., Quantifying the prevalence of frailty in English hospitals, BMJ Open 5 (10) (2015) e008456, http://dx.doi.org/10. 1136/bmjopen-2015-008456. · DOI
- A. Marengoni, S. Angleman, R. Melis, et al., Aging with multimorbidity: a systematic review of the literature, Ageing Res. Rev. 10 (4) (2011) 430-439.
- A. Lovell, P. Yates, Advance care planning in palliative care: a systematic literature review of the contextual factors influencing its uptake 2008-2012, Palliat. Med. 28 (2014) 1026-1035.
- E. Flo, B.S. Husebo, P. Bruusgaard, E. Gjerberg, L. Thoresen, L. Lillemoen, R. Pedersen, A review of the implementation and research strategies of advance care planning in nursing homes, BMC Geriatr. 16 (24) (2016), http://dx.doi. org/10.1186/s12877-016-0179-4. · DOI
- R.S. Martin, B. Hayes, K. Gregorevic, W.K. Lim, The effects of advance care planning interventions on nursing home residents: a systematic review, J. Am. Med. Dir. Assoc. 17 (4) (2016) 284-293 (April 1).
- A. Brinkman-Stoppelenburg, J.A.C. Rietjens, A. van der Heide, The effects of advance care planning on end-of-life care: a systematic review, Palliat. Med. 28 (2014) 1000-1025.
- C.H. Houben, M.A. Spruit, M.T. Groenen, E.F. Wouters, D.J. Janssen, Efficacy of advance care planning: a systematic review and meta-analysis, J. Am. Med. Dir. Assoc. 15 (7) (2014) 477-489.
- L. Robinson, C. Dickinson, N. Rousseau, et al., A systematic review of the effectiveness of advance care planning interventions for people with cognitive impairment and dementia, Age Ageing 41 (2012) 263-269.
- Cochrane Effective Practice and Organisation of Care Group (EPOC) Review Group, Suggested Risk of Bias Criteria for EPOC Reviews, 2014, Retrieved December 3rd, 2014, from https://epoc.cochrane.org/sites/epoc.cochrane.org/ files/uploads/ Suggested%20risk%20of%20bias%20criteria%20for%20EPOC%20reviews.pdf.
- A.S. Epstein, A.E. Volandes, E.M. O'Reilly, Building on individual: state, and federal initiatives for advance care planning, an integral component of palliative and end-of-life cancer care, J. Oncol. Practice 7 (6) (2011) 355-359.
- R. O'Sullivan, A. Murphy, R. O'Caoimh, et al., Economic analysis of systematically implementing a programme of advance care planning in three irish nursing homes, BMC Res. Notes 9 (2016) 237, http://dx.doi.org/10.1186/ s13104-016-2048-9. · DOI
- L.S. Ke, X. Huang, M. O'Connor, S. Lee, Nurses' views regarding implementing advance care planning for older people: a systematic review and synthesis of qualitative studies, J. Clin. Nurs. 24 (15-16) (2015) 2057-2073.
- N. Cornally, C. McGlade, E. Weathers, et al., Evaluating the systematic implementation of the 'Let Me Decide' advance care planning programme in long term care through focus groups: a user's perspective, BMC Palliative Care 14 (2015) 55, http://dx.doi.org/10.1186/s12904-015-0051-x. · DOI
- National Institute for Health and Care Excellence (NICE), Methods for the Development of NICE Public Health Guidance (Third Edition), 2013, Retrieved
- T. Sharp, E. Moran, I. Kuhn, S. Barclay, Do the elderly have a voice? Advance care planning discussions with frail and older individuals: a systematic literature review and narrative synthesis, Br. J. Gen. Practice 63 (615) (2013) e657-e668.
- B. Graverholt, L. Forsetlund, G. Jamtvedt, Reducing hospital admissions from nursing homes: a systematic review, BMC Health Serv. Res. 14 (2014) 36-43.
Cited by
Sorted by citations
McMahan, R. D., Tellez, I., & Sudore, R. L. (2021) · Journal of the American Geriatrics Society · doi:10.1111/jgs.16801 · Cited by 506 · see citing works
European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions
Mentzelopoulos, S. D., Couper, K., Voorde, P. V. D., Druwé, P., Blom, M., Perkins, G. D., Lulic, I., Djakow, J., Raffay, V., Lilja, G., et al. (2021) · Resuscitation · doi:10.1016/j.resuscitation.2021.02.017 · Cited by 246 · see citing works
“reviews indicates that advance care planning increases documentation of patient preferences.(27,30,32,37) 39 Recent studies also reported positive results.”
BackgroundOutcomes of hospital admissions among frail older people: a 2-year cohort study
Keeble, E., Roberts, H. C., Williams, C. D., Van Oppen, J., & Conroy, S. P. (2019) · British Journal of General Practice · doi:10.3399/bjgp19x704621 · Cited by 132 · see citing works
Starr, L. T., Ulrich, C. M., Corey, K. L., & Meghani, S. H. (2019) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909119848148 · Cited by 132 · see citing works
Lin, C.-P., Evans, C. J., Koffman, J., Armes, J., Murtagh, F. E. M., & Harding, R. (2019) · Palliative Medicine · doi:10.1177/0269216318809582 · Cited by 77 · see citing works
- Authors
- Weathers, E., O’Caoimh, R., Cornally, N., Fitzgerald, C., Kearns, T., Coffey, A., Daly, E., O’Sullivan, R., McGlade, C., & Molloy, D. W.
- Affiliations
- Ollscoil na Gaillimhe – University of Galway (IE)
- University College Cork (IE)
- Venue
- Maturitas
- Publisher
- Elsevier BV
- Published
- 2016-09
- Volume
- 91
- Pages
- 101-109
- ISSN
- 0378-5122 (ISSN-L)
- OpenAlex
- W2468466693
- Cited by
- 212
- References
- 4
- Citations by year
- 2026: 6 · 2025: 11 · 2024: 20 · 2023: 22 · 2022: 25 · 2021: 33 · 2020: 31 · 2019: 18 · 2018: 24 · 2017: 19 · 2016: 2 · 2015: 1
- FWCI
- 3.12
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Maturitas (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Arrow@dit (Dublin Institute of Technology) (submittedVersion)
- ARAN (University of Galway Research Repository) (Ollscoil na Gaillimhe – University of Galway) (submittedVersion, cc-by-nc-nd)
- Funders
- Health Research Board
- Health Service Executive
- Irish Hospice Foundation
- 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 › Ethics and bioethics in healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Keywords
- advance care planning, older adults, advance directives, end-of-life care, quality of care, health care utilization, symptom management, nursing homes, patient autonomy, quality of evidence
- MeSH terms
- Aged, Health Services for the Aged, Humans, Randomized Controlled Trials as Topic, Advance Care Planning
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
