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Lookup NU author(s): Patience KunongaORCiD, Dr Katie ThomsonORCiD, Fiona Beyer, Professor Katie Brittain, Professor Dawn CraigORCiD
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).
Context: Advance care planning (ACP) is a comprehensive procedure aimed at helping individuals understand and articulate their values, life goals, and preferences concerning future medical treatment. Despite extensive research on ACP in populations with terminal illnesses, dementia, and those in long-term care, there is a lack of focus on its impact among older adults without life-limiting conditions.Objectives: To investigate the effectiveness, acceptability, and feasibility of ACP for older adults without life-limiting conditions.Methods: We searched 11 electronic databases, spanning from inception to November 2023, complemented by extensive grey literature and reference searches. Rigorous quality assessments were conducted using the Mixed Methods Appraisal Tool (MMAT). Our approach adopted a dynamic convergent mixed-methods design, incorporating thematic and narrative synthesis.Findings: From over 12,600 citations, a total of 16 studies, comprising four randomised controlled trials (RCTs), nine qualitative studies, and three mixed methods studies met the inclusion criteria. Limited findings indicate that ACP interventions are generally effective in improving document completion rates and reducing hospital readmissions. Acceptability and feasibility of these interventions were high, although significantly influenced by cultural and religious factors.Limitations: Evidence supporting the effectiveness, acceptability, and feasibility of ACP in reducing unplanned hospital admissions in older adults without life-limiting conditions was limited. We excluded observations based on unwell older people, though some material with unclear distinctions may have been included. Quality assessments revealed that one of four RCTs had a high risk of bias, three had unclear risks; all nine qualitative studies had low risk; and one of three mixed methods studies had low risk while two had unclear risks.Implications: Further targeted research is necessary to assess the intervention’s value for this population. Rigorous real-world evidence studies involving older adults without life-limiting conditions and their proxies is crucial to enabling providers to tailor ACPs to diverse populations, whilst respecting individuals’ religious and cultural beliefs.
Author(s): Kunonga TP, Thomson KH, Beyer FR, Dawson S, Brittain K, Craig D
Publication type: Article
Publication status: Published
Journal: Journal of Long-term Care
Year: 2024
Pages: 383-402
Online publication date: 15/10/2024
Acceptance date: 20/09/2024
Date deposited: 15/10/2024
ISSN (electronic): 2516-9122
Publisher: LSE Press
URL: https://doi.org/10.31389/jltc.327
DOI: 10.31389/jltc.327
Data Access Statement: All data relevant to the study are included in the article or uploaded as supplemental information
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