State of advance care planning research: A descriptive overview of systematic reviews

被引:34
作者
Jimenez, Geronimo [1 ]
Tan, Woan Shin [1 ,2 ,3 ]
Virk, Amrit K. [1 ]
Low, Chan Kee [4 ]
Car, Josip [1 ,5 ]
Ho, Andy Hau Yan [1 ,6 ,7 ]
机构
[1] Nanyang Technol Univ, Ctr Populat Hlth Sci, Lee Kong Chian Sch Med, Singapore, Singapore
[2] Nanyang Technol Univ, NTU Inst Hlth Technol HealthTech, Interdisciplinary Grad Sch, Singapore, Singapore
[3] Natl Healthcare Grp, Hlth Serv & Outcomes Res Dept, Singapore, Singapore
[4] Nanyang Technol Univ, Econ Programme, Sch Social Sci, Singapore, Singapore
[5] Imperial Coll London, Global eHlth Unit, Dept Primary Care & Publ Hlth, Sch Publ Hlth, London, England
[6] Nanyang Technol Univ, Psychol Programme, Sch Social Sci, Singapore, Singapore
[7] Palliat Care Ctr Excellence Res & Educ, Singapore, Singapore
关键词
Advance care planning; End-of-life care; Palliative care; Overview; Systematic reviews; OF-LIFE CARE; PALLIATIVE CARE; DECISION-MAKING; AFRICAN-AMERICANS; SERIOUS ILLNESS; NURSING-HOMES; OLDER-ADULTS; END; INTERVENTIONS; PEOPLE;
D O I
10.1017/S1478951518000500
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Objective To provide an overview of the current state of research of advance care planning (ACP), highlighting most studied topics, publication time, quality of studies and reported outcomes, and to identify gaps to improve ACP receptivity, utilization, implementation, and outcomes. Method Cochrane methodology for conducting overviews of systematic reviews. Study quality was assessed using a modified version of the Assessing the Methodological Quality of Systematic Reviews tool. The following databases were searched from inception to April 2017: MEDLINE, EBM Reviews, Cochrane Reviews, CINAHL, Global Health, PsycINFO, and EMBASE. Searches were supplemented with gray literature and manual searches. Result Eighty systematic reviews, covering 1,662 single articles, show that ACP-related research focuses on nine main topics: (1) ACP as part of end-of-life or palliative care interventions, (2) care decision-making; (3) communication strategies; (4) factors influencing ACP implementation; (5) ACP for specific patient groups, (6) ACP effectiveness; (7) ACP experiences; (8) ACP cost; and (9) ACP outcome measures. The majority of this research was published since 2014, its quality ranges from moderate to low, and reports on documentation, concordance, preferences, and resource utilization outcomes. Significance of results. Despite the surge of ACP research, there are major knowledge gaps about ACP initiation, timeliness, optimal content, and impact because of the low quality and fragmentation of the available evidence. Research has mostly focused on discrete aspects within ACP instead of using a holistic evaluative approach that takes into account its intricate working mechanisms, the effects of systems and contexts, and the impacts on multilevel stakeholders. Higher quality studies and innovative interventions are needed to develop effective ACP programs and address research gaps.
引用
收藏
页码:234 / 244
页数:11
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