Communication strategies for improving readiness for advance care planning in dementia: A systematic review

BackgroundProgressive cognitive decline in Alzheimer's disease and other dementias limits decision-making, emphasizing the need for timely discussions about preferred future care. However, advance care planning (ACP) is often delayed due to limited readiness among people with dementia and their family caregivers.ObjectiveTo identify communication strategies (interventions and communication methods) improving readiness for ACP among people with dementia and their family caregivers.MethodsA mixed-methods systematic review was conducted (PROSPERO: CRD42023480187). PubMed, The Cochrane Library, Embase, PsycINFO, and CINAHL were searched in January 2024, with an update in February 2025 through expert consultation. Eligible articles included people with dementia and their family caregivers, communication strategies, and readiness for ACP. Study selection was performed independently by multiple reviewers using predefined eligibility criteria. Data were synthesized using a data-based convergent approach.ResultsOf 517 identified articles, ten were included: quantitative (n = 5), mixed-methods (n = 3), and qualitative (n = 2). Eight articles described interventions, including ACP discussions, education, and self-paced, stepwise tools. Multi-component interventions combining facilitated discussions and educational components and tools showed improvements in readiness, although some outcomes were variable across subgroups or over time. Two articles explored communication methods, emphasizing the facilitator relationship and approach, timing and continuity of ACP discussions, and conversational techniques to support engagement.ConclusionsMulti-component interventions, tools, and communication methods may enhance readiness for ACP. Findings highlight the importance of tailoring ACP to individual needs and training healthcare professionals in facilitating ACP. Future research should develop a consistent framework of readiness and identify the active "ingredients" of ACP interventions.