title: Advance care planning: A systematic review of randomised controlled trials conducted with older adults.
abstract: Advance care planning (ACP), involving discussions between patients, families and healthcare professionals on future healthcare decisions, in advance of anticipated impairment in decision-making capacity, improves satisfaction and end-of-life care while respecting patient autonomy. It usually results in the creation of a written advanced care directive (ACD). This systematic review examines the impact of ACP on several outcomes (including symptom management, quality of care and healthcare utilisation) in older adults (>65years) across all healthcare settings. Nine randomised controlled trials (RCTs) were identified by searches of the CINAHL, PubMed and Cochrane databases. A total of 3646 older adults were included (range 72-88 years). Seven studies were conducted with community dwellers and the other two RCTs were conducted in nursing homes. Most studies did not implement a standardised ACD, or measure the impact on quality of end-of-life care or on the death and dying experience. All studies had some risk of bias, with most scoring poorly on the Oxford Quality Scale. While ACP interventions are well received by older adults and generally have positive effects on outcomes, this review highlights the need for well-designed RCTs that examine the economic impact of ACP and its effect on quality of care in nursing homes and other sectors.
authors.affiliation: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas rd, Cork, Ireland; Health Research Board, Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Weathers
authors.affiliation: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas rd, Cork, Ireland; Health Research Board, Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland; COLLAGE (COLLaboration on AGEing), University College Cork, Cork City and Louth Age Friendly County Initiative, Co Louth, Ireland. Electronic address: rocaoimh@hotmail.com.
authors.forename: Rónán
authors.initials: R
authors.lastname: O'Caoimh
authors.affiliation: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas rd, Cork, Ireland; School of Nursing and Midwifery, University College Cork, Western Road, Cork, Ireland.
authors.forename: Nicola
authors.initials: N
authors.lastname: Cornally
authors.affiliation: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas rd, Cork, Ireland.
authors.forename: Carol
authors.initials: C
authors.lastname: Fitzgerald
authors.affiliation: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas rd, Cork, Ireland.
authors.forename: Tara
authors.initials: T
authors.lastname: Kearns
authors.affiliation: School of Nursing and Midwifery, University College Cork, Western Road, Cork, Ireland.
authors.forename: Alice
authors.initials: A
authors.lastname: Coffey
authors.affiliation: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas rd, Cork, Ireland.
authors.forename: Edel
authors.initials: E
authors.lastname: Daly
authors.affiliation: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas rd, Cork, Ireland.
authors.forename: Ronan
authors.initials: R
authors.lastname: O'Sullivan
authors.affiliation: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas rd, Cork, Ireland.
authors.forename: Ciara
authors.initials: C
authors.lastname: McGlade
authors.affiliation: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas rd, Cork, Ireland.
authors.forename: D William
authors.initials: DW
authors.lastname: Molloy
mesh_terms: D032722:Advance Care Planning; D000368:Aged; D006299:Health Services for the Aged; D006801:Humans; D016032:Randomized Controlled Trials as Topic
keywords: Advance care directives; Advance care planning; Older adults; Systematic review