Understanding and optimizing advance care planning implementation for terminally ill older adults: a mixed-methods...

Despite widespread recognition of advance care planning (ACP) benefits, evidence regarding its implementation effectiveness for terminally ill older adults remains inconsistent across healthcare settings and cultural contexts.

Following Joanna Briggs Institute methodology and PRISMA guidelines, this review using a systematic approach synthesized 23 studies (15 RCTs, 8 qualitative) published 2005-2024. Quantitative outcomes were meta-analyzed using Review Manager 5.4; qualitative findings underwent meta-aggregation to identify synthesized themes.

ACP interventions significantly reduced decision conflict, anxiety, and depression while improving end-of-life decision-making rates and preference concordance, though overall quality of life remained unchanged. Three qualitative themes emerged: knowledge-behavior gap, emotional complexity, and multi-factorial decisions, revealing persistent implementation barriers including systemic healthcare constraints and cultural considerations.

Effective ACP implementation requires repositioning it as ongoing patient-paced communication embedded within interdisciplinary care structures, supported by robust continuity mechanisms and cultural adaptations to bridge knowledge-behavior gaps in routine practice.