Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore; NTU Institute of Health Technologies (HealthTech), Interdisciplinary Graduate School, Nanyang Technological University, Singapore, Singapore; Health Services and Outcomes Research Department, National Healthcare Group, Singapore, Singapore.
J Pain Symptom Manage. 2018 Sep;56(3):436-459.e25. doi: 10.1016/j.jpainsymman.2018.05.016. Epub 2018 May 25.
Advance care planning (ACP) involves important decision making about future medical needs. The high-volume and disparate nature of ACP research makes it difficult to grasp the evidence and derive clear policy lessons for policymakers and clinicians.
The aim of this study was to synthesize ACP research evidence and identify relevant contextual elements, program features, implementation principles, and impacted outcomes to inform policy and practice.
An overview of systematic reviews using the Cochrane Handbook of Systematic Reviews of Interventions was performed. Study quality was assessed using a modified version of the AMSTAR (A MeaSurement Tool to Assess Reviews) tool.
MEDLINE, EBM Reviews, Cochrane Reviews, CINAHL, Global Health, PsycINFO, and EMBASE were searched for ACP-related research from inception of each database to April 2017. Searches were supplemented with gray literature and manual searches. Eighty systematic reviews, covering over 1660 original articles, were included in the analysis.
Legislations, institutional policies, and cultural factors influence ACP development. Positive perceptions toward ACP do not necessarily translate into more end-of-life conversations. Many factors related to patients' and providers' attitudes, and perceptions toward life and mortality influence ACP implementation, decision making, and completion. Limited, low-quality evidence points to several ACP benefits, such as improved end-of-life communication, documentation of care preferences, dying in preferred place, and health care savings. Recurring features that make ACP programs effective include repeated and interactive discussion sessions, decision aids, and interventions targeting multiple stakeholders.
Preliminary evidence highlights several elements that influence the ACP process and provides a variety of features that could support successful, effective, and sustainable ACP implementation. However, this evidence is compartmentalized and limited. Further studies evaluating ACP as a unified program and assessing the impact of ACP for different populations, settings, and contexts are needed to develop programs that are able to unleash ACP's full potential.
预先医疗照护计划（ACP）涉及对未来医疗需求的重要决策。ACP 研究数量庞大且性质各异，这使得政策制定者和临床医生难以掌握证据并从中得出明确的政策教训。
本研究旨在综合 ACP 研究证据，并确定相关的背景要素、计划特征、实施原则和受影响的结果，以为政策和实践提供信息。
使用 Cochrane 干预措施系统评价手册对系统评价进行了概述。使用改良版 AMSTAR（评价工具）评估研究质量。
从每个数据库的创建到 2017 年 4 月，在 MEDLINE、EBM Reviews、Cochrane Reviews、CINAHL、全球健康、PsycINFO 和 EMBASE 上搜索与 ACP 相关的研究。此外，还进行了灰色文献和手动搜索。共纳入 80 项系统评价，涵盖了超过 1660 篇原始文章。
立法、机构政策和文化因素影响 ACP 的发展。对 ACP 的积极看法不一定会转化为更多的临终谈话。许多与患者和提供者的态度、对生活和死亡的看法有关的因素会影响 ACP 的实施、决策和完成。有限的、低质量的证据表明 ACP 有几个益处，例如改善临终沟通、记录护理偏好、在首选地点死亡和节省医疗保健费用。使 ACP 计划有效的反复出现的特征包括反复的互动讨论会议、决策辅助工具以及针对多个利益相关者的干预措施。
初步证据强调了影响 ACP 过程的几个要素，并提供了多种支持成功、有效和可持续 ACP 实施的特征。然而，这些证据是零散和有限的。需要进一步研究评估 ACP 作为一个统一的计划，并评估 ACP 对不同人群、环境和背景的影响，以开发能够充分发挥 ACP 潜力的计划。
