"Advance care planning is an effort to consider and communicate one’s values, goals, and preferences as they relate to future healthcare decisions to guide clinicians and loved ones when one is incapable of consenting, refusing, or requesting care. While generally accepted as valuable, advance care planning has proven challenging to evaluate. Goal concordant care is increasingly recognized as the target outcome, but there is no agreed-on methodology for assessment and some question if it can be meaningfully captured. It is ethically necessary to have a strong evidence base to guide practice. The current study is a literature review designed to support best practice for measuring goal concordant care. A database search of Pubmed, Embase, PsycINFO, CINAHL, and Cochrane was conducted in September 2020; articles were included that measured whether advance care planning, defined broadly to consider advance directives, use of proxies, POLSTs, etc., led to goal concordant care. 132 included articles were reviewed according to aim, methodology, and integrity. Common approaches included medical record review 51% (n = 36); questionnaire (36%, n = 48), notably the Decision Conflict Scale (15% of questionnaires, n = 7); and interview (31%, n = 42), often with loved ones after death (40% of interviews, n = 17). Studies, especially those employing medical record review, did not always present enough detail to be reproducible, a concerning limitation. Despite the many existing studies aiming to track whether advance care planning leads to goal concordant care, significant work remains to establish sound methodology to do so meaningfully. "
Do the elderly have a voice? Advance care planning discussions with frail and older individuals: a systematic literature review and narrative synthesis
