Social work involvement in advance care planning post US 2016 Medicare policy change: a systematic review

Since 2016, the US Medicare programme has reimbursed physicians and advanced practice providers for advance care planning (ACP) discussions; however, social workers-who play a critical role in ACP-remain excluded from reimbursement.

This systematic review synthesises empirical evidence published since the 2016 policy change on three aspects of social workers' involvement in ACP: (1) extent of involvement, (2) attitudes and competencies and (3) effectiveness of social worker-led ACP interventions.

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Four databases (PsycINFO, CINAHL, SocINDEX and PubMed) were searched for peer-reviewed studies published between 2016 and October 2025. 19 studies met inclusion criteria.

Findings were synthesised across five domains: social workers' ACP practices, knowledge, attitudes, roles and intervention effectiveness. Across studies, clinical social workers demonstrated strong knowledge of advance directives and reported high levels of confidence in facilitating ACP discussions. Most participants expressed positive attitudes towards ACP and viewed ACP facilitation as a core professional responsibility. Intervention studies suggested that social worker-led ACP initiatives may increase patient engagement in ACP, particularly completion of formal ACP documentation.

The available evidence highlights social workers' substantial contributions to ACP and suggests their potential effectiveness in improving ACP engagement. These findings support ongoing policy discussions regarding the inclusion of social workers in ACP reimbursement frameworks.