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Association between palliative care and the rate of advanced care planning: A systematic review

Published online by Cambridge University Press:  27 November 2019

Shahar Koffler Open the ORCID record for Shahar Koffler [Opens in a new window] ,
Yishai Mintzker  and
Ayelet Shai
Shahar Koffler*
Affiliation:
Azriely Faculty of Medicine, Bar Ilan University, Zafed, Israel
Yishai Mintzker
Affiliation:
Azriely Faculty of Medicine, Bar Ilan University, Zafed, Israel Department of Family Medicine, Maccabbi Health Care Services, Tel Aviv, Israel
Ayelet Shai
Affiliation:
Azriely Faculty of Medicine, Bar Ilan University, Zafed, Israel Department of Oncology, Galilee Medical Center, Nahariya, Israel
*
Author for correspondence: Shahar Koffler, Azriely Faculty of Medicine, Bar Ilan University, Zafed, Israel. E-mail: shaharkoffler@gmail.com
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Abstract

Objective

Advanced care planning (ACP) is central to patients' dignity and autonomy; however, in many countries it is underutilized. Studies that tested the effects of palliative care (PC) often included the rate of documented ACP as a secondary end point. We aimed to assess the contribution of PC to the rate of ACP among terminally ill patients by systematically reviewing relevant clinical trials.

Method

PUBMED and “Cochrane trials” databases were screened for clinical trials published until October 2017 that compared the addition of PC to standard treatment and that had ACP as a primary or a secondary end point. Studies were assessed for validity by three investigators using the Cochrane Collaboration tool and the ROBINS-I tool for randomized controlled trials (RCTs) and for cohort studies, respectively.

Results

Twenty-six trials with 37,924 patients were included. Four were RCTs, nine were cohort studies, and 12 were cross-sectional studies. Randomized trials had the lowest risk of bias. There was a positive correlation between the addition of PC and ACP in 25 studies, among them four randomized trials.

Significance of results

In this systematic review, PC was associated with improvement in the rate of ACP. Understanding the significant effect of PC on the completion of ACP is an additional emphasis on the importance of this treatment among terminally ill patients.

Keywords

Advanced care planningCancerDNRPalliative careTerminally ill
Type
Review Article
Information
Palliative & Supportive Care , Volume 18 , Issue 5 , October 2020 , pp. 589 - 601
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Copyright
Copyright © Cambridge University Press 2019

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Footnotes

*

These two authors contributed equally to this work.

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