Evidence still insufficient that advance care documentation leads to engagement of healthcare professionals in end-of-life discussions: A systematic review

Ebony Lewis, Magnolia Cardona-Morrell, Kok Y. Ong, Steven A. Trankle, Ken Hillman

Research output: Contribution to journalReview articleResearchpeer-review

23 Citations (Scopus)

Abstract

Background: Administration of non-beneficial life-sustaining treatments in terminal elderly patients still occurs due to lack of knowledge of patient's wishes or delayed physician-family communications on preference. Aim: To determine whether advance care documentation encourages healthcare professional's timely engagement in end-of-life discussions. Design: Systematic review of the English language articles published from January 2000 to April 2015. Data sources: EMBASE, MEDLINE, EBM REVIEWS, PsycINFO, CINAHL and Cochrane Library and manual searches of reference lists. Results: A total of 24 eligible articles from 10 countries including 23,914 subjects met the inclusion criteria, mostly using qualitative or mixed methods, with the exception of two cohort studies. The influence of advance care documentation on initiation of end-of-life discussions was predominantly based on perceptions, attitudes, beliefs and personal experience rather than on standard replicable measures of effectiveness in triggering the discussion. While health professionals reported positive perceptions of the use of advance care documentations (18/24 studies), actual evidence of their engagement in end-of-life discussions or confidence gained from accessing previously formulated wishes in advance care documentations was not generally available. Conclusion: Perceived effectiveness of advance care documentation in encouraging end-of-life discussions appears to be high but is mostly derived from low-level evidence studies. This may indicate a willingness and openness of patients, surrogates and staff to perceive advance directives as an instrument to improve communication, rather than actual evidence of timeliness or effectiveness from suitably designed studies. The assumption that advance care documentations will lead to higher physicians' confidence or engagement in communicating with patients/families could not be objectively demonstrated in this review.

Original languageEnglish
Pages (from-to)807-824
Number of pages18
JournalPalliative Medicine
Volume30
Issue number9
DOIs
Publication statusPublished - 1 Oct 2016
Externally publishedYes

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Documentation
Delivery of Health Care
Communication
Advance Directives
Information Storage and Retrieval
Family Physicians
MEDLINE
Libraries
Cohort Studies
Language
Physicians
Health

Cite this

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title = "Evidence still insufficient that advance care documentation leads to engagement of healthcare professionals in end-of-life discussions: A systematic review",
abstract = "Background: Administration of non-beneficial life-sustaining treatments in terminal elderly patients still occurs due to lack of knowledge of patient's wishes or delayed physician-family communications on preference. Aim: To determine whether advance care documentation encourages healthcare professional's timely engagement in end-of-life discussions. Design: Systematic review of the English language articles published from January 2000 to April 2015. Data sources: EMBASE, MEDLINE, EBM REVIEWS, PsycINFO, CINAHL and Cochrane Library and manual searches of reference lists. Results: A total of 24 eligible articles from 10 countries including 23,914 subjects met the inclusion criteria, mostly using qualitative or mixed methods, with the exception of two cohort studies. The influence of advance care documentation on initiation of end-of-life discussions was predominantly based on perceptions, attitudes, beliefs and personal experience rather than on standard replicable measures of effectiveness in triggering the discussion. While health professionals reported positive perceptions of the use of advance care documentations (18/24 studies), actual evidence of their engagement in end-of-life discussions or confidence gained from accessing previously formulated wishes in advance care documentations was not generally available. Conclusion: Perceived effectiveness of advance care documentation in encouraging end-of-life discussions appears to be high but is mostly derived from low-level evidence studies. This may indicate a willingness and openness of patients, surrogates and staff to perceive advance directives as an instrument to improve communication, rather than actual evidence of timeliness or effectiveness from suitably designed studies. The assumption that advance care documentations will lead to higher physicians' confidence or engagement in communicating with patients/families could not be objectively demonstrated in this review.",
author = "Ebony Lewis and Magnolia Cardona-Morrell and Ong, {Kok Y.} and Trankle, {Steven A.} and Ken Hillman",
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Evidence still insufficient that advance care documentation leads to engagement of healthcare professionals in end-of-life discussions : A systematic review. / Lewis, Ebony; Cardona-Morrell, Magnolia; Ong, Kok Y.; Trankle, Steven A.; Hillman, Ken.

In: Palliative Medicine, Vol. 30, No. 9, 01.10.2016, p. 807-824.

Research output: Contribution to journalReview articleResearchpeer-review

TY - JOUR

T1 - Evidence still insufficient that advance care documentation leads to engagement of healthcare professionals in end-of-life discussions

T2 - A systematic review

AU - Lewis, Ebony

AU - Cardona-Morrell, Magnolia

AU - Ong, Kok Y.

AU - Trankle, Steven A.

AU - Hillman, Ken

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Background: Administration of non-beneficial life-sustaining treatments in terminal elderly patients still occurs due to lack of knowledge of patient's wishes or delayed physician-family communications on preference. Aim: To determine whether advance care documentation encourages healthcare professional's timely engagement in end-of-life discussions. Design: Systematic review of the English language articles published from January 2000 to April 2015. Data sources: EMBASE, MEDLINE, EBM REVIEWS, PsycINFO, CINAHL and Cochrane Library and manual searches of reference lists. Results: A total of 24 eligible articles from 10 countries including 23,914 subjects met the inclusion criteria, mostly using qualitative or mixed methods, with the exception of two cohort studies. The influence of advance care documentation on initiation of end-of-life discussions was predominantly based on perceptions, attitudes, beliefs and personal experience rather than on standard replicable measures of effectiveness in triggering the discussion. While health professionals reported positive perceptions of the use of advance care documentations (18/24 studies), actual evidence of their engagement in end-of-life discussions or confidence gained from accessing previously formulated wishes in advance care documentations was not generally available. Conclusion: Perceived effectiveness of advance care documentation in encouraging end-of-life discussions appears to be high but is mostly derived from low-level evidence studies. This may indicate a willingness and openness of patients, surrogates and staff to perceive advance directives as an instrument to improve communication, rather than actual evidence of timeliness or effectiveness from suitably designed studies. The assumption that advance care documentations will lead to higher physicians' confidence or engagement in communicating with patients/families could not be objectively demonstrated in this review.

AB - Background: Administration of non-beneficial life-sustaining treatments in terminal elderly patients still occurs due to lack of knowledge of patient's wishes or delayed physician-family communications on preference. Aim: To determine whether advance care documentation encourages healthcare professional's timely engagement in end-of-life discussions. Design: Systematic review of the English language articles published from January 2000 to April 2015. Data sources: EMBASE, MEDLINE, EBM REVIEWS, PsycINFO, CINAHL and Cochrane Library and manual searches of reference lists. Results: A total of 24 eligible articles from 10 countries including 23,914 subjects met the inclusion criteria, mostly using qualitative or mixed methods, with the exception of two cohort studies. The influence of advance care documentation on initiation of end-of-life discussions was predominantly based on perceptions, attitudes, beliefs and personal experience rather than on standard replicable measures of effectiveness in triggering the discussion. While health professionals reported positive perceptions of the use of advance care documentations (18/24 studies), actual evidence of their engagement in end-of-life discussions or confidence gained from accessing previously formulated wishes in advance care documentations was not generally available. Conclusion: Perceived effectiveness of advance care documentation in encouraging end-of-life discussions appears to be high but is mostly derived from low-level evidence studies. This may indicate a willingness and openness of patients, surrogates and staff to perceive advance directives as an instrument to improve communication, rather than actual evidence of timeliness or effectiveness from suitably designed studies. The assumption that advance care documentations will lead to higher physicians' confidence or engagement in communicating with patients/families could not be objectively demonstrated in this review.

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DO - 10.1177/0269216316637239

M3 - Review article

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SP - 807

EP - 824

JO - Palliative Medicine

JF - Palliative Medicine

SN - 0269-2163

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