Community-Based Interventions for Initiating Early End-of-Life Conversations in Nonterminally Ill Adults: A...

Area of Science:

• Public Health
• Gerontology
• Health Services Research

Background:

• End-of-life (EOL) conversations and advanced care planning (ACP) are crucial for maintaining autonomy and dignity.
• Understanding the effectiveness of community-based interventions for early EOL and ACP initiation in non-terminally ill adults is limited.

Purpose of the Study:

• To systematically review and meta-analyze community-based interventions for initiating early ACP conversations and EOL planning behaviors.
• To provide a comprehensive summary to inform international adoption of such implementations.

Main Methods:

• Systematic review and meta-analysis of 71 articles from a search of 30,869 abstracts across multiple databases.
• Included non-terminally ill adults (18+ years) in community settings, focusing on interventions promoting EOL/ACP education.
• Assessed completion of EOL/ACP behaviors and knowledge, attitudes, and perceptions (KAP) using standardized mean difference (SMD).

Main Results:

• Community-based EOL interventions significantly increased EOL/ACP behaviors (RR=2.24) and positive perceptions (SMD=1.24) compared to usual care.
• Workshop and discussion group interventions showed greater effectiveness in promoting EOL and ACP.
• Findings were robust across sensitivity analyses, including studies with low risk-of-bias.

Conclusions:

• Community-based interventions effectively enhance EOL/ACP behaviors and perceptions among the non-terminally ill.
• Future interventions should focus on community contextualization and co-creation with community figures for improved generalizability.