Interventions Guiding Advance Care Planning Conversations: A Systematic Review

Area of Science:

• Medical Ethics
• Health Communication
• Patient-Centered Care

Background:

• Advance care planning (ACP) is crucial for defining future medical preferences.
• Conversation guides aim to support professionals in conducting ACP discussions.
• Essential components of effective ACP guides require further investigation.

Purpose of the Study:

• To evaluate the content and rationale of ACP interventions utilizing conversation guides.
• To assess the empirical evidence on the effectiveness of these ACP interventions.
• To identify key elements within ACP conversation guides.

Main Methods:

• Systematic literature search of multiple databases (MEDLINE, Embase, PsycINFO, CINAHL) from 1998 to 2018.
• Thematic analysis of 34 unique ACP conversation guides from 82 included articles.
• Extraction of intervention characteristics, rationale, and empirical evidence, with risk of bias and quality assessment.

Main Results:

• ACP guides typically follow a four-phase structure: preparation, initiation, exploration, and action.
• Guides emphasize exploring patient perspectives on illness, well-being, end-of-life issues, and decision-making.
• While most studies showed increased dyad congruence and preference documentation, effects on knowledge, decisional conflict, and preference-concordant care were variable.

Conclusions:

• ACP conversation guides cover diverse themes related to illness, end-of-life care, and decision-making, focusing on patient perspectives.
• Evidence suggests these guides can improve documentation of preferences.
• Limited evidence exists on how explored information translates into specific treatment preferences and subsequent care.