Vignette-based approaches in advance care planning: a scoping review

The objective of this scoping review is to systematically map evidence on vignette applications in advance care planning (ACP), with a focus on vignette formats, target populations and outcomes for patients and caregivers.

Scoping review following Arksey and O'Malley's methodological framework and reported according to PRISMA-ScR guidelines.

Medline, Web of Science, CINAHL, Scopus and reference lists were systematically searched in December 2025.

We included original empirical studies (quantitative, qualitative or mixed-methods) that evaluated the use of vignettes (written, video, virtual reality or mixed) as measurement, education, decision-support or communication tools in ACP among adults facing or potentially facing serious illness in healthcare or community settings.

Two independent reviewers screened and appraised studies using JBI study-design-specific Critical Appraisal Tools. Data were extracted using a pre-designed, standardised chart form. Results were descriptively synthesised across the participants, vignette characteristics and outcomes.

From 1479 records, 16 original studies were included. Vignettes have evolved from traditional text-based scenarios to video-supported and virtual reality tools, with study populations expanding from specific clinical patients to the general adult population. Primary outcomes include improved knowledge, clarified and changed medical preferences, increased ACP behaviour and improved communication. Vignettes operate through three key pathways: serve as cognitive anchors to enhance medical literacy and ACP understanding; provide low-stakes simulated scenarios that promote value-concordant preferences; and offer a depersonalised platform that facilitates communication without triggering defensive responses. While well accepted, vignettes may trigger distress, and their effectiveness depends on cultural adaptation that reconciles Western autonomous preferences with Eastern familial decision-making frameworks.

Vignettes are a valuable and acceptable tool for translating abstract end-of-life values into concrete, preference-concordant decisions. Future research should prioritise standardised and culturally adapted vignette protocols and evaluate the translation of hypothetical preferences into real-world ACP behaviours through longitudinal studies.