Adele J Kelly1, Tim Luckett2, Josephine M Clayton1,3,4, Liam Gabb5, Slavica Kochovska2, Meera Agar2,6,7. 1. HammondCare, Sydney, Australia. 2. Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, Australia. 3. Palliative Care Service, Greenwich and Royal North Shore Hospitals, Sydney, Australia. 4. Kolling Institute, Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia. 5. Princess Royal University Hospital, Kings College Hospital NHS Foundation Trust, UK. 6. South Western Sydney Clinical School, University of New South Wales, Sydney, Australia. 7. Ingham Institute of Applied Medical Research, Sydney, Australia.
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.
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.
Entities:
Keywords:
Dementia; advance care directives; advance care planning; death; decision-making; dying; end-of-life care; systematic review
Authors: Jenny T van der Steen; Sten Heck; Carla Cm Juffermans; Mirjam Marjolein Garvelink; Wilco P Achterberg; Josephine Clayton; Genevieve Thompson; Raymond Tcm Koopmans; Yvette M van der Linden Journal: BMJ Open Date: 2021-04-12 Impact factor: 2.692
Authors: Stein Erik Fæø; Oscar Tranvåg; Rune Samdal; Bettina S Husebo; Frøydis K Bruvik Journal: BMC Health Serv Res Date: 2020-11-16 Impact factor: 2.655