scholarly journals Barriers, enablers and initiatives for uptake of advance care planning in general practice: a systematic review and critical interpretive synthesis

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e030275 ◽  
Author(s):  
Jo Risk ◽  
Leila Mohammadi ◽  
Joel Rhee ◽  
Lucie Walters ◽  
Paul R Ward
Keyword(s):  
Systematic Review ◽  
General Practice ◽  
Advance Care Planning ◽  
Models Of Care ◽  
Cochrane Library ◽  
Care Planning ◽  
Barriers And Enablers ◽  
Critical Interpretive Synthesis ◽  
Explicit Consideration ◽  
Advance Care

ObjectivesHow advance care planning (ACP) is conceptualised in Australia including when, where and how ACP is best initiated, is unclear. It has been suggested that healthcare delivered in general practice provides an optimal setting for initiation of ACP discussions but uptake remains low. This systematic review and critical interpretive synthesis sought to answer two questions: (1) What are the barriers and enablers to uptake of ACP in general practice? (2) What initiatives have been used to increase uptake of ACP in general practice?DesignA systematic review and critical interpretive synthesis of the peer-reviewed literature was undertaken. A socioecological framework was used to interpret and map the literature across four contextual levels of influence including individual, interpersonal, provider and system levels within a general practice setting.SettingPrimary care general practice settingsData sourcesSearches were undertaken from inception to July 2019 across Ovid Medline, Cumulative Index to Nursing and Allied Health Literature, Scopus, ProQuest and Cochrane Library of systematic reviews.ResultsThe search yielded 4883 non-duplicate studies which were reduced to 54 studies for synthesis. Year of publication ranged from 1991 to 2019 and represented research from nine countries. Review findings identified a diverse and disaggregated body of ACP literature describing barriers and enablers to ACP in general practice, and interventions testing single or multiple mechanisms to improve ACP generally without explicit consideration for level of influence. There was a lack of cohesive guidance in shaping effective ACP interventions and some early indications of structured approaches emerging.ConclusionFindings from this review present an opportunity to strategically apply the ACP research evidence across targeted levels of influence, and with an understanding of mediators and moderators to inform the design of new and enhanced ACP models of care in general practice.PROSPERO registration numberCRD42018088838

Palliative care service utilization and advance care planning issues for adult glioblastoma patients: A systematic review.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 2036-2036
Author(s):  
Adela Wu ◽  
Gabriela Ruiz Colon ◽  
Rebecca Aslakson ◽  
Erqi L. Pollom ◽  
Chirag B Patel
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
End Of Life ◽  
Advance Care Planning ◽  
Cochrane Library ◽  
Care Planning ◽  
Inclusion Criteria ◽  
Financial Barriers ◽  
Home Setting ◽  
Advance Care

2036 Background: Glioblastoma (GBM) is a devastating disease with a median survival under 2 years and a 10-year survival rate of 0.71%. As patients with GBM suffer simultaneously from both a terminal cancer and a neurodegenerative disease, proactive provision of advance care planning (ACP) and palliative care (PC) seem appropriate. We conducted a systematic review exploring the published literature on the prevalence of ACP, healthcare services utilization at the end of life (EOL, including PC services), and location of death among adults with GBM, and the experiences of their caregivers. Methods: We systematically searched PubMed, Embase, Scopus, and Cochrane Library from database inception until 12/20/2020, using search terms including ‘glioblastoma’, ‘end of life’, ‘advance care planning’, and ‘advance directive’. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed. Inclusion criteria were quantitative and qualitative studies written in English of adults with GBM and their caregivers, with at least 20 subjects. Included studies were assessed for quality using the Newcastle-Ottawa Scale. Results: We screened 344 article abstracts and 39 full text articles to yield a final cohort of 16 articles that fit inclusion criteria. These studies reported the experiences of 10,706 GBM patients and 123 caregivers. All were nonrandomized studies conducted in six countries with all but two published in 2014 or later. Across studies, ACP documentation varied from 4-55%, PC referral was pursued in 39-40% of cases, and hospice referrals were made for 66-76% of adult GBM patients. Hospitalizations frequently occurred at the EOL, 20-56% of patients spent over 25% of their overall survival time hospitalized, and 39-64 % of deaths occurred in the home setting. Caregivers commonly reported restrictions on their ability to work (60%), financial barriers to care (29%), and feeling unprepared (29%). Conclusions: Despite having both a terminal disease and neurocognitive decline, a majority of adults with GBM do not pursue ACP or have access to PC. There is a dearth of focused and high-quality studies on ACP, PC, and hospice use among adults with GBM. Prospective studies that address these and additional aspects related to end-of-life care in this population, such as healthcare costs and inpatient supportive care needs, are needed.

Advance care planning, palliative care, and end-of-life care interventions for homeless people: A systematic review

2016 ◽  
Vol 31 (2) ◽  
pp. 109-119 ◽  
Author(s):  
Rafael Sumalinog ◽  
Katy Harrington ◽  
Naheed Dosani ◽  
Stephen W Hwang
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Homeless Persons ◽  
Cochrane Library ◽  
Care Planning ◽  
Life Care ◽  
Advance Care

Background: Homeless individuals have a high prevalence of multiple chronic comorbidities and early mortality compared to the general population. They also experience significant barriers to access and stigmatization in the healthcare system. Providing advance care planning, palliative care, and end-of-life care for this underserved population is an important health issue. Aim: To summarize and evaluate the evidence surrounding advance care planning, palliative care, and end-of-life care interventions for homeless persons. Design: A systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data sources: Articles from MEDLINE, EMBASE, CINAHL, PsycINFO, Social Work Abstracts, Cochrane Library, Web of Science, and PubMed databases were searched through 13 June 2015. Peer-reviewed studies that implemented advance care planning, palliative care, and end-of-life care interventions for homeless populations were included. Data from studies were independently extracted by two investigators using pre-specified criteria, and quality was assessed using modified Cochrane and Critical Appraisal Skills Programme tools. Results: Six articles met inclusion criteria. Two studies were randomized controlled trials involving advance directive completion. Two cohort studies investigated the costs of a shelter-based palliative care intervention and predictors for completing advance directives. These studies were rated low to fair quality. Two qualitative studies explored the interface between harm-reduction services and end-of-life care and the conditions for providing palliative care for homeless persons in a support home. Conclusion: The effectiveness of advance care planning, palliative care, and end-of-life care interventions for homeless individuals is uncertain. High-quality studies of interventions that reflect the unique and complex circumstances of homeless populations and investigate patient-related outcomes, caregiver burden, and cost-effectiveness are needed.

Gamification for promoting advance care planning: A mixed-method systematic review and meta-analysis

2021 ◽  
pp. 026921632110053
Author(s):  
Li Liu ◽  
Ya-Yi Zhao ◽  
Chen Yang ◽  
Helen Yue-Lai Chan
Keyword(s):  
Systematic Review ◽  
Advance Care Planning ◽  
Mixed Method ◽  
Meta Analysis ◽  
Feasibility Studies ◽  
Biomedical Literature ◽  
Cochrane Library ◽  
Care Planning ◽  
Quantitative Evidence ◽  
Advance Care

Background: Gamification has been adopted in the health care field for broaching sensitive topics and increasing motivation for behavior changes. Games developed to stimulate discussion surrounding end-of-life issues, and thereby promoting advance care planning also emerged. Aim: The aim is to integrate the quantitative evidence and qualitative evidence to understand the effectiveness of and experience with games for advance care planning. Design: A mixed-methods systematic review and meta-analysis (PROSPERO ID: CRD42020163312) was undertaken. Joanna Briggs Institute Critical Appraisal tools were used for quality appraisal. Data were synthesized and pooled for meta-analysis or meta-aggregation when appropriate. Data sources: We searched MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Library, WanFang, China Knowledge Resource Integrated Database, and Chinese Biomedical Literature Database from the inception of the databases for qualitative, quantitative, and mixed-method studies. Results: Eleven articles of ten studies were included, six of which were feasibility studies. The quality of the quantitative component of most included studies (7/8) was rated as low, and the qualitative component of most included studies (7/8) was rated as moderate. The meta-analysis showed that games for advance care planning are effective to increase self-efficacy, readiness, knowledge, and process of advance care planning behaviors. The meta-aggregation showed that games for advance care planning are highly acceptable and the participants perceived the game experience as fun and enjoyable. Conclusions: Advance care planning games seem to be a promising intervention for increasing the uptake of advance care planning behaviors. Well-designed randomized controlled trials evaluating the effectiveness of games for advance care planning are needed in the future.

scholarly journals Preconditions for successful advance care planning in nursing homes: A systematic review

2017 ◽  
Vol 66 ◽  
pp. 47-59 ◽  
Author(s):  
Joni Gilissen ◽  
Lara Pivodic ◽  
Tinne Smets ◽  
Chris Gastmans ◽  
Robert Vander Stichele ◽  
...  
Keyword(s):  
Systematic Review ◽  
Nursing Homes ◽  
Advance Care Planning ◽  
Care Planning ◽  
Advance Care

O-77 Effects of advance care planning in patients with cancer. results from a systematic review

2015 ◽  
Vol 5 (Suppl 2) ◽  
pp. A24.3-A24
Author(s):  
Jan Schildmann ◽  
C Bausewein ◽  
Tanja Krones ◽  
A Simon ◽  
ST Simon ◽  
...  
Keyword(s):  
Systematic Review ◽  
Advance Care Planning ◽  
Care Planning ◽  
Patients With Cancer ◽  
Advance Care

13 Exploring patient safety incidents arising from advance care planning for end of life patients: a mixed methods analysis of incident reports

2018 ◽  
Vol 8 (3) ◽  
pp. 364.2-365 ◽  
Author(s):  
Toby Dinnen ◽  
Huw Williams ◽  
Simon Noble ◽  
Adrian Edwards ◽  
Joyce Kenkre ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Safety ◽  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Care Planning ◽  
Life Care ◽  
Advance Care ◽  
Incident Reports ◽  
Patient Safety Incidents

IntroductionAdvance Care Planning (ACP) is an important component of patient centred end-of-life care (Houben et al. 2014; Brinkman-Stoppelenburg et al. 2014). However there is little evidence available on the safety of the process and its impact on quality of care.AimTo characterise the nature of patient safety incidents arising around the ACP process for patients approaching end-of-life.MethodThe National Reporting and Learning System (NRLS) collates patient safety incident reports across England and Wales. We performed a keyword search and manual review to identify relevant reports between 2005 and 2015. A mixed methods process combining structured data coding and exploratory descriptive analysis was undertaken to describe incidents underlying causes and outcomes. A thematic analysis identified areas on which to focus improvement initiatives.ResultsWe identified 67 incident reports in which patients experienced inadequate care due to issues with implementation of ACP. The most common source of error was (mis)communication of ACP (n=27) where documentation was lost or verbal handover was inaccurate. Over one third of reports (n=24) described an ACP not being followed. In the remaining reports (n=16) an ACP was not completed despite being appropriate. The most common contributory factor was inadequate staff knowledge (n=18). Common outcomes were cardiopulmonary resuscitation attempts contrary to a patient’s wishes (n=18). Other outcomes included inappropriate treatment or transfer/admission.ConclusionOur national level analysis identifies key priorities which should be explored in local contexts: specifically improving public and staff understanding and engagement with ACP and developing systems for recording and accessing ACP documentation across healthcare services.References. Brinkman-Stoppelenburg A, Rietjens JA, Van Der Heide A. The effects of advance care planning on end-of-life care: A systematic review. Palliative Medicine2014;28:1000–25.. Houben CH, Spruit MA, Groenen MT, Wouters EF, Janssen DJ. Efficacy of advance care planning: A systematic review and meta-analysis. Journal of the American Medical Directors Association2014;15:477–89.

scholarly journals OP59 Complex interventions guiding advance care planning conversations: a systematic review

2019 ◽  
Author(s):  
J Fahner ◽  
A Beunders ◽  
J van Delden ◽  
A Van der Heide ◽  
M Vanderschuren ◽  
...  
Keyword(s):  
Systematic Review ◽  
Advance Care Planning ◽  
Complex Interventions ◽  
Care Planning ◽  
Advance Care
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