Background

Advance care planning is a communication and decision-making process during which people express their wishes for future healthcare and treatment decisions. Advance care planning is particularly relevant to frail older adults. Recently, more advance care planning interventions have been implemented in nursing homes using randomised controlled trial approaches; however, no meta-analysis has been performed evaluating and synthesising the effect of advance care planning in nursing homes.

Objective

To determine the effect of advance care planning interventions on end-of-life outcomes in nursing home populations.

Design

Systematic review and meta-analysis of randomised controlled trials.

Data sources

Medline, EMBASE, Cochrane Library, Medical database, British Nursing Index, PsycInfo and CINAHL Plus from inception to March 2021.

Review methods

Randomised controlled trials or cluster randomised controlled trials implementing advance care planning interventions in nursing homes, and studies reporting end-of-life outcomes and published in English were included. Studies in which advance care planning was part of a more comprehensive intervention were excluded. The outcomes were evaluated using pooled odds ratios (ORs) or standardised mean differences (SMDs) with random-effects meta-analysis models. A meta-regression was performed to evaluate the heterogeneity of the included studies. The Cochrane Risk of Bias Tool 2.0 was used to assess the methodological quality of the included studies.

Results

Nine trials were identified with 2905 participants, with sample sizes ranging from 87 to 1292. The number of nursing homes involved ranged from 1 to 64. The types of advance care planning intervention differed, with most studies adopting formal education or training for nursing home staff, while the remainder adopted train-the-trainer approaches. The quality of the included studies varied, with two out of nine scoring low in overall risk of bias. Our comprehensive meta-analysis indicated with moderate heterogeneity that advance care planning interventions significantly increased the documentation of end-of-life care preferences (OR = 1.95, 95% CI: 1.64, 2.32), but not satisfaction with end-of-life care from families' perspectives (SMD = 0.08, 95% CI: − 0.08, 0.23). The meta-regression did not identify any variables in advance care planning interventions to explain the heterogeneity.

Conclusion

Advance care planning intervention yielded beneficial effects in nursing home residents by increasing the number of documented end-of-life care wishes but demonstrated no effect on satisfaction with end-of-life care from family caregivers' perspectives. This review highlights the need for more rigorously designed implementation studies to examine the effects of advance care planning interventions on healthcare outcomes among frail older adults in nursing homes.

中文翻译：

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预先护理计划干预对疗养院居民的影响：随机对照试验的系统评价和荟萃分析

背景

预先护理计划是一个沟通和决策过程，人们在此过程中表达他们对未来医疗保健和治疗决策的愿望。预先护理计划与体弱的老年人特别相关。最近，使用随机对照试验方法在疗养院实施了更多的预先护理计划干预措施；然而，尚未进行荟萃分析评估和综合养老院预先护理计划的效果。

客观的

确定预先护理计划干预对疗养院人群临终结果的影响。

设计

随机对照试验的系统评价和荟萃分析。

数据源

Medline、EMBASE、Cochrane 图书馆、医学数据库、英国护理索引、PsycInfo 和 CINAHL Plus，从成立到 2021 年 3 月。

审查方法

包括在疗养院实施预先护理计划干预的随机对照试验或整群随机对照试验，以及报告临终结果并以英文发表的研究。预先护理计划是更全面干预的一部分的研究被排除在外。使用合并优势比 (OR) 或标准化平均差 (SMD) 和随机效应荟萃分析模型评估结果。进行元回归以评估纳入研究的异质性。Cochrane 偏倚风险工具 2.0 用于评估纳入研究的方法学质量。

结果

确定了 9 项试验，有 2905 名参与者，样本量从 87 到 1292 不等。涉及的疗养院数量从 1 到 64 不等。预先护理计划干预的类型不同，大多数研究对疗养院工作人员进行正规教育或培训，而其余​​的则采用了培训培训师的方法。纳入研究的质量各不相同，九分之二的总体偏倚风险得分较低。我们的综合荟萃分析表明，预先护理计划干预显着增加了对临终护理偏好的记录（OR = 1.95, 95% CI: 1.64, 2.32），但对临终护理的满意度不高从家庭的角度来看（SMD = 0.08, 95% CI：- 0.08, 0.23)。元回归没有发现预先护理计划干预中的任何变量来解释异质性。

结论

预先护理计划干预通过增加记录在案的临终护理愿望的数量对疗养院居民产生了有益的影响，但从家庭护理人员的角度来看，这对临终护理的满意度没有影响。本综述强调需要进行更严格设计的实施研究，以检查预先护理计划干预对疗养院中体弱老年人医疗保健结果的影响。