The Effects of Advance Care Planning Interventions in the Older Population: A Systematic Review and Meta-Analysis

Objective: To systematically review the effects of advance care planning (ACP) interventions in the older population across diverse cultural contexts, with a particular focus on comparing intervention characteristics and outcomes between Asian and Western countries. Methods: Studies published since 2000 and written in English were identified from Medline, Cochrane, CINAHL, and PubMed. Meta-analysis was performed to pool the main outcomes. Results: A total of 32 studies were involved in the data analysis. The review concluded that ACP interventions significantly increased the completion of ACP documents, the occurrence of ACP/end-of-life (EoL) care discussions, the consistency between preferred and actual EoL care, and ACP engagement among the older population. It also implied that ACP interventions had potential effects on increasing the preference for comfort care and do-not-resuscitate orders, as well as improved ACP knowledge. However, we found that ACP probably had no effect on healthcare utilization and mortality, and its impact on the quality of life, satisfaction, care costs, and older individuals' participation in the decision-making process remained unknown with insufficient evidence. Additionally, cultural beliefs, auxiliary materials, and personnel capacity presented the differences in ACP intervention characteristics between Asian and Western countries. Conclusions: ACP has beneficial effects in the older population. Further high-quality intervention studies are needed to identify the most culturally adapted ACP interventions for the older population in various settings to make full use of the advantages of ACP. Addressing cultural beliefs is essential to improving ACP in Asian countries.

Duke Scholars

Author Bei Wu School of Nursing