scholarly journals Clinician-targeted interventions to improve advance care planning in heart failure: a systematic review and meta-analysis

Heart ◽  
2019 ◽  
Vol 105 (17) ◽  
pp. 1316-1324 ◽  
Author(s):  
Markus Schichtel ◽  
Bee Wee ◽  
Rafael Perera ◽  
Igho Onakpoya ◽  
Charlotte Albury ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Advance Care Planning ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Reminder Systems ◽  
Care Planning ◽  
Advance Care ◽  
Educational Meetings

ObjectiveAdvance care planning (ACP) is widely advocated to contribute to better outcomes for patients suffering from heart failure. But clinicians appear hesitant to engage with ACP. Our aim was to identify interventions with the greatest potential to engage clinicians with ACP in heart failure.MethodsA systematic review and meta-analysis. We searched CINAHL, Cochrane Central Register of Controlled Trials, Database of Systematic Reviews, Embase, ERIC, Ovid MEDLINE, Science Citation Index and PsycINFO for randomised controlled trials (RCTs) from inception to January 2018. Three reviewers independently extracted data, assessed risk of bias (Cochrane risk of bias tool), the quality of evidence (GRADE) and intervention synergy according to Template for Intervention Description and Replication. ORs were calculated for pooled effects.ResultsOf 14 175 articles screened, we assessed the full text of 131 studies. 13 RCTs including 3709 participants met all of the inclusion criteria. The intervention categories of patient-mediated interventions (OR 5.23; 95% CI 2.36 to 11.61), reminder systems (OR 3.65; 95% CI 1.47 to 9.04) and educational meetings (OR 2.35; 95% CI 1.29 to 4.26) demonstrated a favourable effect to engage clinicians with the completion of ACP.ConclusionThe review provides evidence from 13 published RCTs and suggests that interventions that involve patients to change clinical practice, reminder systems and educational meetings have the greatest effect in improving the implementation of ACP in heart failure.

Effect of Behavior Change Techniques Targeting Clinicians to Improve Advance Care Planning in Heart Failure: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Markus Schichtel ◽  
Bee Wee ◽  
Rafael Perera ◽  
Igho Onakpoya ◽  
Charlotte Albury
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Behavior Change ◽  
Goal Setting ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Care Planning ◽  
Behavior Change Techniques ◽  
Advance Care

Abstract Background National and international guidelines recommend advance care planning (ACP) for patients with heart failure. But clinicians seem hesitant to engage with ACP. Purpose Our aim was to identify behavioral interventions with the greatest potential to engage clinicians with ACP in heart failure. Methods A systematic review and meta-analysis. We searched CINAHL, Cochrane Central Register of Controlled Trials, Database of Systematic Reviews, Embase, ERIC, Ovid MEDLINE, Science Citation Index, and PsycINFO for randomized controlled trials (RCTs) from inception to August 2018. Three reviewers independently extracted data, assessed risk of bias (Cochrane risk of bias tool), the quality of evidence (Grading of Recommendation Assessment, Development, and Evaluation), and intervention synergy according to the behavior change wheel and behavior change techniques (BCTs). Odds ratios (ORs) were calculated for pooled effects. Results Of 14,483 articles screened, we assessed the full text of 131 studies. Thirteen RCTs including 3,709 participants met all of the inclusion criteria. The BCTs of prompts/cues (OR: 4.18; 95% confidence interval [CI]: 2.03–8.59), credible source (OR: 3.24; 95% CI: 1.44–7.28), goal setting (outcome; OR: 2.67; 95% CI: 1.56–4.57), behavioral practice/rehearsal (OR: 2.64; 95% CI: 1.50–4.67), instruction on behavior performance (OR: 2.49; 95% CI: 1.63–3.79), goal setting (behavior; OR: 2.12; 95% CI: 1.57–2.87), and information about consequences (OR: 2.06; 95% CI: 1.40–3.05) showed statistically significant effects to engage clinicians with ACP. Conclusion Certain BCTs seem to improve clinicians’ practice with ACP in heart failure and merit consideration for implementation into routine clinical practice.

scholarly journals The Effect of Advance Care Planning on Heart Failure: a Systematic Review and Meta-analysis

2019 ◽  
Vol 35 (3) ◽  
pp. 874-884 ◽  
Author(s):  
Markus Schichtel ◽  
Bee Wee ◽  
Rafael Perera ◽  
Igho Onakpoya
Keyword(s):  
Heart Failure ◽  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Meta Analysis ◽  
Care Planning ◽  
Life Care ◽  
Advance Care

Abstract Background Advance care planning is widely advocated to improve outcomes in end-of-life care for patients suffering from heart failure. But until now, there has been no systematic evaluation of the impact of advance care planning (ACP) on clinical outcomes. Our aim was to determine the effect of ACP in heart failure through a meta-analysis of randomized controlled trials (RCTs). Methods We searched CINAHL, Cochrane Central Register of Controlled Trials, Database of Systematic Reviews, Embase, ERIC, Ovid MEDLINE, Science Citation Index and PsycINFO (inception to July 2018). We selected RCTs including adult patients with heart failure treated in a hospital, hospice or community setting. Three reviewers independently screened studies, extracted data, assessed the risk of bias (Cochrane risk of bias tool) and evaluated the quality of evidence (GRADE tool) and analysed interventions according to the Template for Intervention Description and Replication (TIDieR). We calculated standardized mean differences (SMD) in random effects models for pooled effects using the generic inverse variance method. Results Fourteen RCTs including 2924 participants met all of the inclusion criteria. There was a moderate effect in favour of ACP for quality of life (SMD, 0.38; 95% CI [0.09 to 0.68]), patients’ satisfaction with end-of-life care (SMD, 0.39; 95% CI [0.14 to 0.64]) and the quality of end-of-life communication (SMD, 0.29; 95% CI [0.17 to 0.42]) for patients suffering from heart failure. ACP seemed most effective if it was introduced at significant milestones in a patient’s disease trajectory, included family members, involved follow-up appointments and considered ethnic preferences. Several sensitivity analyses confirmed the statistically significant direction of effect. Heterogeneity was mainly due to different study settings, length of follow-up periods and compositions of ACP. Conclusions ACP improved quality of life, patient satisfaction with end-of-life care and the quality of end-of-life communication for patients suffering from heart failure and could be most effective when the right timing, follow-up and involvement of important others was considered.

Efficacy of Advance Care Planning: A Systematic Review and Meta-Analysis

2014 ◽  
Vol 15 (7) ◽  
pp. 477-489 ◽  
Author(s):  
Carmen H.M. Houben ◽  
Martijn A. Spruit ◽  
Miriam T.J. Groenen ◽  
Emiel F.M. Wouters ◽  
Daisy J.A. Janssen
Keyword(s):  
Systematic Review ◽  
Advance Care Planning ◽  
Meta Analysis ◽  
Care Planning ◽  
Advance Care

scholarly journals Advance care planning: A systematic review of randomised controlled trials conducted with older adults

Maturitas ◽  
2016 ◽  
Vol 91 ◽  
pp. 101-109 ◽  
Author(s):  
Elizabeth Weathers ◽  
Rónán O’Caoimh ◽  
Nicola Cornally ◽  
Carol Fitzgerald ◽  
Tara Kearns ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Advance Care Planning ◽  
Randomised Controlled Trials ◽  
Controlled Trials ◽  
Care Planning ◽  
Advance Care ◽  
Randomised Controlled

scholarly journals The conceptual models and mechanisms of action that underpin advance care planning for cancer patients: A systematic review of randomised controlled trials

2018 ◽  
Vol 33 (1) ◽  
pp. 5-23 ◽  
Author(s):  
Cheng-Pei Lin ◽  
Catherine J Evans ◽  
Jonathan Koffman ◽  
Jo Armes ◽  
Fliss E M Murtagh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cancer Patients ◽  
Advance Care Planning ◽  
Randomised Controlled Trials ◽  
Conceptual Models ◽  
Mechanisms Of Action ◽  
Controlled Trials ◽  
Care Planning ◽  
Advance Care ◽  
Randomised Controlled

Background: No systematic review has focused on conceptual models underpinning advance care planning for patients with advanced cancer, and the mechanisms of action in relation to the intended outcomes. Aim: To appraise conceptual models and develop a logic model of advance care planning for advanced cancer patients, examining the components, processes, theoretical underpinning, mechanisms of action and linkage with intended outcomes. Design: A systematic review of randomised controlled trials was conducted, and was prospectively registered on PROSPERO. Narrative synthesis was used for data analysis. Data sources: The data sources were MEDLINE, CINAHL, PsycINFO, EMBASE, CENTRAL, PROSPERO, CareSearch, and OpenGrey with reference chaining and hand-searching from inception to 31 March 2017, including all randomised controlled trials with advance care planning for cancer patients in the last 12 months of life. Cochrane quality assessment tool was used for quality appraisal. Results: Nine randomised controlled trials were included, with only four articulated conceptual models. Mechanisms through which advance care planning improved outcomes comprised (1) increasing patients’ knowledge of end-of-life care, (2) strengthening patients’ autonomous motivation, (3) building patients’ competence to undertake end-of-life discussions and (4) enhancing shared decision-making in a trustful relationship. Samples were largely highly educated Caucasian. Conclusion: The use of conceptual models underpinning the development of advance care planning is uncommon. When used, they identify the individual behavioural change. Strengthening patients’ motivation and competence in participating advance care planning discussions are key mechanisms of change. Understanding cultural feasibility of the logic model for different educational levels and ethnicities in non-Western countries should be a research priority.

scholarly journals Video decision aids to assist with advance care planning: a systematic review and meta-analysis

BMJ Open ◽  
2015 ◽  
Vol 5 (6) ◽  
pp. e007491 ◽  
Author(s):  
Ashu Jain ◽  
Sophie Corriveau ◽  
Kathleen Quinn ◽  
Amanda Gardhouse ◽  
Daniel Brandt Vegas ◽  
...  
Keyword(s):  
Systematic Review ◽  
Advance Care Planning ◽  
Meta Analysis ◽  
Decision Aids ◽  
Care Planning ◽  
Advance Care
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