Updating knowledge on existing approaches on advanced care planning interventions: An umbrella review

Advanced care planning (ACP) can reduce hospitalizations, increase quality of life, and align treatment with patient wishes, while lowering healthcare costs. However, healthcare providers' discomfort, lack of training, and patient anxiety may hinder ACP. Furthermore, disparities exist among minority and low-income groups. Growing research highlights the need for standardized definitions and broader implementation, especially post-COVID-19, incorporating digital tools, economic impacts, ethics, and family roles to improve ACP worldwide.

This study aims to update and synthesize knowledge from all published systematic reviews from the past ten years, focusing on ACP-related interventions.

We conducted a comprehensive search across PubMed, Cochrane, and Scopus, including only English-language, peer-reviewed systematic reviews published between 2015 and 2025. We employed rigorous screening, dual-reviewer validation, and quality-assessment tools, and synthesized evidence on intervention effectiveness across diverse populations and settings to identify effective ACP strategies.

Of the deduplicated 7513 records, 61 reviews met the inclusion criteria. For older adult patients, structured conversations reduce unnecessary aggressive treatments and align end-of-life care with preferences. Among racial groups, peer support and palliative consultations boost ACP completion. Patient-centric interventions include video decision aids and web tools, whereas provider-centric interventions include conversation guides, reminder systems, electronic coordination platforms, and facilitator training.

ACP is an ongoing process tailored to patient preferences, requiring efforts to address stigmatized conversations, especially in minority communities and severe illnesses. Emphasis on research into digital tools, policy incentives, infrastructure, and family support is essential. Bridging research and practice will improve outcomes and patient-centered end-of-life care.

This article describes an umbrella review of 61 systematic reviews on advanced care planning-related interventions. The analysis indicates that the reviews covered interventions focusing on both facility and community-based individuals and had a specific population or disease focus. The articles covered both patient and provider-centric interventions.