The current state and future direction of palliative care : a systematic review of advance care planning and advance directive

• Main Author: Tay, Nicole Siu Yeung
• Other Authors: Ho Hau Yan Andy
• Format: Final Year Project
• Language: English
• Published: 2015
• Subjects: DRNTU::Social sciences::Psychology
• Online Access: http://hdl.handle.net/10356/65784
• Institution: Nanyang Technological University

Since the modern Hospice Movement of the 1960s, the field of palliative care has matured and made tremendous progress towards reducing pain and improving symptom management among those facing terminal illness. It was not until the dawn of the twenty-first century, marked by global ageing and increasing prevalence of chronic diseases, has the demand for palliative care became more urgent and evident. Today, Advance care planning and Advance directives are two major palliative care interventions that seek to enhance patients’ autonomy and their quality of life at the end of life. As these interventions gain popularity around most developed countries, a rise in relevant efficacy research have also been observed. This paper first provides a brief historic overview of hospice and palliative care from a global perspective. Second, it elaborates on the contemporary development of advance directives and advance care planning as well as major practice models adopted by the United States, United Kingdom and Singapore. Third, it presents the findings of a systematic review that critically evaluates the effectiveness of advance care planning and advance directives for improving the quality of life of older adults with life-limiting illness. Based on the 22 identified empirical articles, it is found that most research employed outcome statistics that are not directly related to the fundamental construct of quality of life and hence challenging their validity; while others reported mixed results. Hence the effectiveness of advance care planning remains elusive. Finally, recommendations for improving future research as well as clinical practice are discussed.