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Advance care planning in different settings for people with dementia: A systematic review and narrative synthesis

Published online by Cambridge University Press:  10 June 2019

Adele J. Kelly ,
Tim Luckett ,
Josephine M. Clayton ,
Liam Gabb ,
Slavica Kochovska  and
Meera Agar
Adele J. Kelly
Affiliation:
HammondCare, Sydney, Australia
Tim Luckett*
Affiliation:
Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, Australia
Josephine M. Clayton
Affiliation:
HammondCare, Sydney, Australia Palliative Care Service, Greenwich and Royal North Shore Hospitals, Sydney, Australia Kolling Institute, Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia
Liam Gabb
Affiliation:
Princess Royal University Hospital, Kings College Hospital NHS Foundation Trust, UK
Slavica Kochovska
Affiliation:
Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, Australia
Meera Agar
Affiliation:
Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, Australia South Western Sydney Clinical School, University of New South Wales, Sydney, Australia Ingham Institute of Applied Medical Research, Sydney, Australia
*
Author for correspondence: Tim Luckett, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), zFaculty of Health, University of Technology Sydney, Sydney, Australia. E-mail: tim.luckett@uts.edu.au
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Abstract

Background

Advance care planning (ACP) is identified as being an important process for people with dementia. However, its efficacy for improving outcomes relevant for the individual, carers and the health system has yet to be established.

Aim

We conducted a systematic review with the aims of testing the efficacy of ACP for people with dementia and describing the settings and population in which it has been evaluated.

Methods

A search was completed of electronic databases in August 2016. Articles were included if they described interventions aimed at increasing planning for future care of people with dementia, delivered to the person with dementia, their carers and/or health professionals.

Results

Of 4,772 articles returned by searches, 30 met the inclusion criteria, testing interventions in nursing home (n= 16) community (n = 10) and acute care (n = 4) settings. Only 18 interventions directly involved the person with dementia, with the remainder focusing on surrogate decision-makers. In all settings, interventions were found effective in increasing ACP practice. In nursing homes, ACP was found to influence care and increase the concordance between end of life wishes and care provided. Interventions in the community were found to improve patient quality of life but were not shown to influence concordance.

Conclusion

Future research should focus on ways to involve people with dementia in decision-making through supported means.

Keywords

Dementiaend-of-life careadvance care planningsystematic reviewdecision-makingadvance care directivesdeathdying
Type
Review Article
Information
Palliative & Supportive Care , Volume 17 , Issue 6 , December 2019 , pp. 707 - 719
Copyright
Copyright © Cambridge University Press 2019 

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