scholarly journals Predictors of Mortality in Patients with Advanced Cancer—A Systematic Review and Meta-Analysis

Cancers ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 328
Author(s):  
Catherine Owusuaa ◽  
Simone A. Dijkland ◽  
Daan Nieboer ◽  
Agnes van der Heide ◽  
Carin C. D. van der Rijt
Keyword(s):  
Advance Care Planning ◽  
Prediction Models ◽  
Meta Analysis ◽  
Performance Status ◽  
Risk Of Bias ◽  
Care Planning ◽  
Random Effects Model ◽  
Discriminative Ability ◽  
Predictors Of Mortality ◽  
Advance Care

To timely initiate advance care planning in patients with advanced cancer, physicians should identify patients with limited life expectancy. We aimed to identify predictors of mortality. To identify the relevant literature, we searched Embase, MEDLINE, Cochrane Central, Web of Science, and PubMed databases between January 2000–April 2020. Identified studies were assessed on risk-of-bias with a modified QUIPS tool. The main outcomes were predictors and prediction models of mortality within a period of 3–24 months. We included predictors that were studied in ≥2 cancer types in a meta-analysis using a fixed or random-effects model and summarized the discriminative ability of models. We included 68 studies (ranging from 42 to 66,112 patients), of which 24 were low risk-of-bias, and 39 were included in the meta-analysis. Using a fixed-effects model, the predictors of mortality were: the surprise question, performance status, cognitive impairment, (sub)cutaneous metastases, body mass index, comorbidity, serum albumin, and hemoglobin. Using a random-effects model, predictors were: disease stage IV (hazard ratio [HR] 7.58; 95% confidence interval [CI] 4.00–14.36), lung cancer (HR 2.51; 95% CI 1.24–5.06), ECOG performance status 1+ (HR 2.03; 95% CI 1.44–2.86) and 2+ (HR 4.06; 95% CI 2.36–6.98), age (HR 1.20; 95% CI 1.05–1.38), male sex (HR 1.24; 95% CI 1.14–1.36), and Charlson comorbidity score 3+ (HR 1.60; 95% CI 1.11–2.32). Thirteen studies reported on prediction models consisting of different sets of predictors with mostly moderate discriminative ability. To conclude, we identified reasonably accurate non-tumor specific predictors of mortality. Those predictors could guide in developing a more accurate prediction model and in selecting patients for advance care planning.

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.

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

Determining the influence of patient-perceived curability on advance care planning in patients with cancer.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 198-198
Author(s):  
Cameron Pywell ◽  
Aidan Gilbert ◽  
Rachel Charles ◽  
Star Ye ◽  
Gabrielle Betty Rocque
Keyword(s):  
Marital Status ◽  
Advance Care Planning ◽  
Early Stage ◽  
Performance Status ◽  
Eastern Cooperative Oncology Group ◽  
Patient Specific ◽  
Care Planning ◽  
Likelihood Ratios ◽  
Patient Reported ◽  
Advance Care

198 Background: Advance Care Planning (ACP) allows patients to express their wishes regarding medical interventions when they are no longer able to make decisions. We hypothesized that among cancer patients treated at the University of Alabama at Birmingham (UAB), those who perceived their disease to be incurable were more likely to have an ACP. Methods: This cross-sectional study utilized data from patient reported outcome (PRO) surveys administered at the UAB outpatient oncology clinic. PRO responses included Eastern Cooperative Oncology Group (ECOG) performance status, perceived curability, and ACP status. Clinical and demographic information abstracted from the electronic health record included sex, stage, disease progression, phase of care (treatment: diagnosis to 1 year; survivorship: 1 year to 6 months before death; end of life: 6 months prior to death), diagnosis date, race, and marital status. The association between perceived curability and ACP was evaluated using likelihood ratios (LR) and 95% confidence intervals (CI) from generalized linear models with a log link and Poisson distribution with robust variance estimates adjusting for sex, race, stage, phase of care, ECOG, and marital status. Results: We analyzed PRO responses from 818 patients with a variety of different cancers. The majority of patients were female (68%), white (74%), were married (61%), had an early stage (0/I/II/III) cancer with no progression (56%), and had an ECOG of 0 or 1 (74%). Gynecologic (30%) and hematologic (28%) were the most common malignancies. The majority of patients were in the treatment (46%) or survivorship (48%) phase of care. Most patients did not have an ACP (59%). The majority of patients believed that their cancer was curable (61%). In adjusted models, there was no difference in ACP status between those believing their cancer was curable versus incurable (LR: 0.97, CI: 0.77-1.23). Conclusions: The absence of difference in ACP with respect to perceived curability suggests that patients’ completion of ACP depends on other factors, which may be more patient-specific rather than disease-specific. Our data reinforce the importance of addressing ACP for all patients.

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

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.

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.

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