Overview of systematic reviews of advance care planning : summary of evidence and global lessons

Background: Advance care planning (ACP) involves important decision making about future medical needs. The high-volume and disparate nature of ACP research makes it difficult to grasp the evidence and derive clear policy lessons for policymakers and clinicians. Aim: The aim of this study was to synt...

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Main Authors: Jimenez, Geronimo, Tan, Woan Shin, Virk, Amrit K., Low, Chan Kee, Car, Josip, Ho, Andy Hau Yan
Other Authors: School of Social Sciences
Format: Article
Language:English
Published: 2019
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Online Access:https://hdl.handle.net/10356/87181
http://hdl.handle.net/10220/49865
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Institution: Nanyang Technological University
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spelling sg-ntu-dr.10356-871812020-11-01T05:24:18Z Overview of systematic reviews of advance care planning : summary of evidence and global lessons Jimenez, Geronimo Tan, Woan Shin Virk, Amrit K. Low, Chan Kee Car, Josip Ho, Andy Hau Yan School of Social Sciences Interdisciplinary Graduate School (IGS) Lee Kong Chian School of Medicine (LKCMedicine) NTU Institute for Health Technologies Science::Medicine End-of-life Care Advance Care planning Background: Advance care planning (ACP) involves important decision making about future medical needs. The high-volume and disparate nature of ACP research makes it difficult to grasp the evidence and derive clear policy lessons for policymakers and clinicians. Aim: The aim of this study was to synthesize ACP research evidence and identify relevant contextual elements, program features, implementation principles, and impacted outcomes to inform policy and practice. Design: An overview of systematic reviews using the Cochrane Handbook of Systematic Reviews of Interventions was performed. Study quality was assessed using a modified version of the AMSTAR (A MeaSurement Tool to Assess Reviews) tool. Data Sources: MEDLINE, EBM Reviews, Cochrane Reviews, CINAHL, Global Health, PsycINFO, and EMBASE were searched for ACP-related research from inception of each database to April 2017. Searches were supplemented with gray literature and manual searches. Eighty systematic reviews, covering over 1660 original articles, were included in the analysis. Results: Legislations, institutional policies, and cultural factors influence ACP development. Positive perceptions toward ACP do not necessarily translate into more end-of-life conversations. Many factors related to patients' and providers' attitudes, and perceptions toward life and mortality influence ACP implementation, decision making, and completion. Limited, low-quality evidence points to several ACP benefits, such as improved end-of-life communication, documentation of care preferences, dying in preferred place, and health care savings. Recurring features that make ACP programs effective include repeated and interactive discussion sessions, decision aids, and interventions targeting multiple stakeholders. Conclusions: Preliminary evidence highlights several elements that influence the ACP process and provides a variety of features that could support successful, effective, and sustainable ACP implementation. However, this evidence is compartmentalized and limited. Further studies evaluating ACP as a unified program and assessing the impact of ACP for different populations, settings, and contexts are needed to develop programs that are able to unleash ACP's full potential. MOH (Min. of Health, S’pore) Published version 2019-09-04T06:09:41Z 2019-12-06T16:36:39Z 2019-09-04T06:09:41Z 2019-12-06T16:36:39Z 2018 Journal Article Jimenez, G., Tan, W. S., Virk, A. K., Low, C. K., Car, J., & Ho, A. H. Y. (2018). Overview of systematic reviews of advance care planning : summary of evidence and global lessons. Journal of Pain and Symptom Management, 56(3), 436-459. doi:10.1016/j.jpainsymman.2018.05.016 0885-3924 https://hdl.handle.net/10356/87181 http://hdl.handle.net/10220/49865 10.1016/j.jpainsymman.2018.05.016 en Journal of Pain and Symptom Management © 2018 The Author(s). Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). 49 p. application/pdf
institution Nanyang Technological University
building NTU Library
continent Asia
country Singapore
Singapore
content_provider NTU Library
collection DR-NTU
language English
topic Science::Medicine
End-of-life Care
Advance Care planning
spellingShingle Science::Medicine
End-of-life Care
Advance Care planning
Jimenez, Geronimo
Tan, Woan Shin
Virk, Amrit K.
Low, Chan Kee
Car, Josip
Ho, Andy Hau Yan
Overview of systematic reviews of advance care planning : summary of evidence and global lessons
description Background: Advance care planning (ACP) involves important decision making about future medical needs. The high-volume and disparate nature of ACP research makes it difficult to grasp the evidence and derive clear policy lessons for policymakers and clinicians. Aim: The aim of this study was to synthesize ACP research evidence and identify relevant contextual elements, program features, implementation principles, and impacted outcomes to inform policy and practice. Design: An overview of systematic reviews using the Cochrane Handbook of Systematic Reviews of Interventions was performed. Study quality was assessed using a modified version of the AMSTAR (A MeaSurement Tool to Assess Reviews) tool. Data Sources: MEDLINE, EBM Reviews, Cochrane Reviews, CINAHL, Global Health, PsycINFO, and EMBASE were searched for ACP-related research from inception of each database to April 2017. Searches were supplemented with gray literature and manual searches. Eighty systematic reviews, covering over 1660 original articles, were included in the analysis. Results: Legislations, institutional policies, and cultural factors influence ACP development. Positive perceptions toward ACP do not necessarily translate into more end-of-life conversations. Many factors related to patients' and providers' attitudes, and perceptions toward life and mortality influence ACP implementation, decision making, and completion. Limited, low-quality evidence points to several ACP benefits, such as improved end-of-life communication, documentation of care preferences, dying in preferred place, and health care savings. Recurring features that make ACP programs effective include repeated and interactive discussion sessions, decision aids, and interventions targeting multiple stakeholders. Conclusions: Preliminary evidence highlights several elements that influence the ACP process and provides a variety of features that could support successful, effective, and sustainable ACP implementation. However, this evidence is compartmentalized and limited. Further studies evaluating ACP as a unified program and assessing the impact of ACP for different populations, settings, and contexts are needed to develop programs that are able to unleash ACP's full potential.
author2 School of Social Sciences
author_facet School of Social Sciences
Jimenez, Geronimo
Tan, Woan Shin
Virk, Amrit K.
Low, Chan Kee
Car, Josip
Ho, Andy Hau Yan
format Article
author Jimenez, Geronimo
Tan, Woan Shin
Virk, Amrit K.
Low, Chan Kee
Car, Josip
Ho, Andy Hau Yan
author_sort Jimenez, Geronimo
title Overview of systematic reviews of advance care planning : summary of evidence and global lessons
title_short Overview of systematic reviews of advance care planning : summary of evidence and global lessons
title_full Overview of systematic reviews of advance care planning : summary of evidence and global lessons
title_fullStr Overview of systematic reviews of advance care planning : summary of evidence and global lessons
title_full_unstemmed Overview of systematic reviews of advance care planning : summary of evidence and global lessons
title_sort overview of systematic reviews of advance care planning : summary of evidence and global lessons
publishDate 2019
url https://hdl.handle.net/10356/87181
http://hdl.handle.net/10220/49865
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