TY - JOUR
T1 - Association between palliative care and the rate of advanced care planning
T2 - A systematic review
AU - Koffler, Shahar
AU - Mintzker, Yishai
AU - Shai, Ayelet
N1 - Publisher Copyright:
© Cambridge University Press 2019.
PY - 2020/10
Y1 - 2020/10
N2 - 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.
AB - 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.
KW - Advanced care planning
KW - Cancer
KW - DNR
KW - Palliative care
KW - Terminally ill
UR - http://www.scopus.com/inward/record.url?scp=85097967851&partnerID=8YFLogxK
U2 - 10.1017/s1478951519001068
DO - 10.1017/s1478951519001068
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C2 - 31771672
AN - SCOPUS:85097967851
SN - 1478-9515
VL - 18
SP - 589
EP - 601
JO - Palliative and Supportive Care
JF - Palliative and Supportive Care
IS - 5
ER -