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Cited by 60Palliative Care and End-of-Life IssuesPalliative and Oncologic CarePatient-Provider Communication in Healthcare

Advance care planning in patients with primary malignant brain tumors: a systematic review

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Song, Krystal, Amatya, Bhasker, Voutier, Catherine, Khan, Fary·2016·Frontiers in Oncology
DOI 10.3389/fonc.2016.00223PMC PMC5075571
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Abstract

Advance care planning (ACP) is a process of reflection and communication of a person's future health care preferences, and has been shown to improve end-of-life (EOL) care for patients. The aim of this systematic review is to present an evidence-based overview of ACP in patients with primary malignant brain tumors (pmBT). A comprehensive literature search was conducted using medical and health science electronic databases (PubMed, Cochrane, Embase, MEDLINE, ProQuest, Social Care Online, Scopus, and Web of Science) up to July 2016. Manual search of bibliographies of articles and gray literature search were also conducted. Two independent reviewers selected studies, extracted data, and assessed the methodologic quality of the studies using the Critical Appraisal Skills Program's appraisal tools. All studies were included irrespective of the study design. A meta-analysis was not possible due to heterogeneity amongst included studies; therefore, a narrative analysis was performed for best evidence synthesis. Overall, 19 studies were included [1 randomized controlled trial (RCT), 17 cohort studies, 1 qualitative study] with 4686 participants. All studies scored "low to moderate" on the methodological quality assessment, implying high risk of bias. A single RCT evaluating a video decision support tool in facilitating ACP in pmBT patients showed a beneficial effect in promoting comfort care and gaining confidence in decision-making. However, the effect of the intervention on quality of life and care at the EOL were unclear. There was a low rate of use of ACP discussions at the EOL. Advance directive completion rates and place of death varied between different studies. Positive effects of ACP included lower hospital readmission rates, and intensive care unit utilization. None of the studies assessed mortality outcomes associated with ACP. In conclusion, this review found some beneficial effects of ACP in pmBT. The literature still remains limited in this area, with lack of intervention studies, making it difficult to identify superiority of ACP interventions in pmBT. More robust studies, with appropriate study design, outcome measures, and defined interventions are required to inform policy and practice.

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  • Caregiver QoL and support needs may be particularly noticeable during transitions in care progression, treatment failure, and end-of-life periods when symptom burden escalates or care coordination intensifies.

    “Caregiver QoL and support needs may be particularly noticeable during transitions in care progression, treatment failure, and end-of-life periods when symptom burden escalates or care coordination intensifies.12”

    From Caregiver burden, quality of life, and psychosocial outcomes among informal caregivers of patients with glioma: A systematic review and meta-analysis (2026) · cites this paper as [12]

    The Results (Synthesis of Results; page unavailable) report generally low caregiver QoL during the illness trajectory and discuss caregivers’ experiences of end-of-life care and transitions between healthcare settings. The Results (Study Characteristics; page unavailable) describe increasing family-support and care intensity during disease progression and at end of life. The review does not specifically identify treatment failure as a period of heightened caregiver need or show that escalating symptoms or care coordination make caregiver QoL needs more noticeable. (LLM, conf=0.84)

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Cited by

Sorted by citations

Authors
Song, K., Amatya, B., Voutier, C., & Khan, F.
Affiliations
  • The Royal Melbourne Hospital (AU)
  • The University of Melbourne (AU)
Corresponding author
Song, Krystal
ORCID
Venue
Frontiers in Oncology
Publisher
Frontiers Media SA
Published
2016-10-24
Volume
6
Pages
223-223
ISSN
2234-943X (ISSN-L)
DOI
10.3389/fonc.2016.00223
PMC
PMC5075571
OpenAlex
W2534559495
Cited by
60
References
1
Citations by year
2026: 4 · 2025: 5 · 2024: 7 · 2023: 4 · 2022: 7 · 2021: 7 · 2020: 3 · 2019: 10 · 2018: 9 · 2017: 3
FWCI
1.10
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Frontiers in Oncology (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by)
  • Monash University Research Portal (Monash University) (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
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 › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
Keywords
advance care planning, primary malignant brain tumors, end-of-life care, advance directives, hospital readmission, intensive care utilization, place of death, quality of life, patient decision-making

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