Association Between Advance Care Planning and Place of Death: A Systematic Review and Meta-Analysis

Place of death is a key indicator of quality in end-of-life care, reflecting how well care aligns with patients' values and preferences. Advance care planning (ACP) has been proposed to support goal-concordant care, yet evidence regarding its association with actual place of death remains inconsistent.

To examine the association between participation in ACP and place of death and to explore whether this association varies according to ACP implementation method.

In this systematic review and meta-analysis, we searched five databases (PubMed, Embase, PsycInfo, CINAHL, and ProQuest) for studies published in English from inception to September 2025. Studies of adults engaged in ACP and reporting actual place of death were included. Random-effects meta-analyses were conducted, with subgroup analyses by documentation-based or discussion-based ACP implementation methods. Risk of bias and certainty were assessed using RoB 2, ROBINS-I V2, and GRADE.

Of 4216 records, 13 studies were included. ACP was associated with increased home death and reduced hospital death, with considerable heterogeneity. For home death, discussion-based implementation showed a significant association, whereas documentation-based implementation did not. For hospital death, both implementation methods were associated with reduced odds.

ACP is associated with place of death, but its impact appears to depend on how it is implemented. These findings suggest that ACP should be approached as a communication-centered process rather than solely as documentation. Clinicians should prioritize facilitated discussions that clarify patient values and preferences, and integrate them into care planning. Future implementation efforts should focus on strengthening communication processes and care coordination to support goal-concordant end-of-life care, particularly in enabling home-based death.

PROSPERO (CRD420251236312).