Clinician-targeted interventions to improve advance care planning in heart failure: a systematic review and...

Area of Science:

• Cardiology
• Healthcare Management
• Medical Ethics

Background:

• Advance care planning (ACP) is crucial for improving outcomes in heart failure (HF) patients.
• Clinician engagement with ACP remains a significant challenge in HF management.
• Identifying effective interventions to promote clinician participation in ACP is essential.

Purpose of the Study:

• To identify interventions with the greatest potential to engage clinicians in advance care planning for heart failure patients.
• To systematically review and analyze randomized controlled trials (RCTs) evaluating ACP interventions in heart failure.

Main Methods:

• A systematic review and meta-analysis of RCTs was conducted, searching multiple databases.
• Data extraction, risk of bias assessment (Cochrane tool), and evidence quality evaluation (GRADE) were performed by three independent reviewers.
• Intervention synergy was assessed using the Template for Intervention Description and Replication (TIDieR) framework, with odds ratios (ORs) calculated for pooled effects.

Main Results:

• Out of 14,175 screened articles, 13 RCTs with 3,709 participants met the inclusion criteria.
• Patient-mediated interventions (OR 5.23), reminder systems (OR 3.65), and educational meetings (OR 2.35) showed a significant positive effect in engaging clinicians with ACP completion.
• These interventions demonstrated favorable odds ratios, indicating their effectiveness in promoting ACP.

Conclusions:

• Interventions involving patients in practice change, reminder systems, and educational meetings are most effective in enhancing ACP implementation in heart failure.
• The findings provide evidence-based strategies for healthcare providers and institutions to improve ACP rates in heart failure.
• These approaches can lead to better patient care and outcomes by ensuring timely and appropriate advance care planning.