title: The effects of advance care planning on end-of-life care: a systematic review.
abstract: BACKGROUND
  Advance care planning is the process of discussing and recording patient preferences concerning goals of care for patients who may lose capacity or communication ability in the future. Advance care planning could potentially improve end-of-life care, but the methods/tools used are varied and of uncertain benefit. Outcome measures used in existing studies are highly variable.
  
  
  OBJECTIVE
  To present an overview of studies on the effects of advance care planning and gain insight in the effectiveness of different types of advance care planning.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  We systematically searched PubMed, EMBASE and PsycINFO databases for experimental and observational studies on the effects of advance care planning published in 2000-2012.
  
  
  RESULTS
  The search yielded 3571 papers, of which 113 were relevant for this review. For each study, the level of evidence was graded. Most studies were observational (95%), originated from the United States (81%) and were performed in hospitals (49%) or nursing homes (32%). Do-not-resuscitate orders (39%) and written advance directives (34%) were most often studied. Advance care planning was often found to decrease life-sustaining treatment, increase use of hospice and palliative care and prevent hospitalisation. Complex advance care planning interventions seem to increase compliance with patients' end-of-life wishes.
  
  
  CONCLUSIONS
  The effects of different types of advance care planning have been studied in various settings and populations using different outcome measures. There is evidence that advance care planning positively impacts the quality of end-of-life care. Complex advance care planning interventions may be more effective in meeting patients' preferences than written documents alone. More studies are needed with an experimental design, in different settings, including the community.
authors.affiliation: Department of Public Health, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands a.brinkman-stoppelenburg@erasmusmc.nl.
authors.forename: Arianne
authors.initials: A
authors.lastname: Brinkman-Stoppelenburg
authors.affiliation: Department of Public Health, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands.
authors.forename: Judith A C
authors.initials: JA
authors.lastname: Rietjens
authors.affiliation: Department of Public Health, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands.
authors.forename: Agnes
authors.initials: A
authors.lastname: van der Heide
mesh_terms: D032722:Advance Care Planning; D016223:Advance Directives; D017051:Hospice Care / Q000639:trends*; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D057240:Patient Preference; D016414:Resuscitation Orders; D013727:Terminal Care / Q000592:standards
keywords: Advance care planning; advance directives; living wills; resuscitation orders