The effects of advance care planning on end-of-life care

Arianne Brinkman-Stoppelenburg, MSc, researcher in the department of Public Health, Erasmus MC, Rotterdam, The Netherlands, explains the background to her longer research article that has been selected as Editor’s Choice in the September edition of Palliative Medicine.

Advance care planning is the process of discussing and recording patient preferences concerning goals of care for patients who may lose capacity or communication ability in the future. It enables patients and their families to consider what care and treatments might or might not be acceptable, and to try and make plans in line with their wishes. In our recent review to be published in Palliative Medicine, we investigated the effects of advance care planning on end-of-life care.

Arianne Brinkman-Stoppelenburg

What was the motive for performing this review?
In our department of Public Health at Erasmus MC, it’s good practice to start your PhD-trajectory by writing a review on a relevant (end-of life care) topic. Reading more about the topic, I became interested in advance care planning because it is a broad concept, involving a range of interventions and outcomes. Over the past years, the focus of advance care planning has shifted from the completion of written forms, to the social process. Advance care planning is now considered as an important aspect of end-of-life care. This made me curious about the effects of advance care planning on end-of-life care.

What was the aim of the study?
The aim of the study was to get insight into different forms and programmes of advance care planning, and to explore the effects on end-of-life care. In this review, we wanted to give a broad overview; therefore we chose to include different types of advance care planning and outcomes. We checked whether the search strategy covered studies from different countries, as not all countries use the same terminology.

What were the main findings?
We conclude that there is evidence that advance care planning positively impacts on the quality of end-of-life care. Complex advance care planning interventions may be more effective in meeting patients’ preferences than written documents alone. Few studies have been performed on the effects of advance care planning in the Netherlands and in Europe. More studies are needed with an experimental design, in different settings, including the community, also in the Netherlands and other European countries.

What have you learned?
I have learned that it takes a lot of effort to perform a good review. The definition of a proper search strategy, including relevant Mesh-terms, and defining good inclusion and exclusion criteria takes a lot of time at the start, but it turned out to be very worthwhile later on in the process of selecting papers.

How can this study be used in practice?
The review was helpful in preparing the study proposal for the ACTION trial (Advance Care Planning – An Innovative Palliative Care Intervention to Improve Quality of Life in Oncology), a large cluster randomised trial in six European countries that assessed the effects of advance care planning on symptom burden and quality of life of patients with advanced cancer. I hope this review will provide a useful overview of the current literature and that it helps to identify possible gaps that could be addressed with further research.

Read the full article in the September issue of Palliative Medicine

Read the longer article in ‘Palliative Medicine’
This post relates to the longer article, ‘The effects of advance care planning on end-of-life care: A systematic review’ by Arianne Brinkman-Stoppelenburg, MSc, Dr Judith AC Rietjens and Dr Agnes van der Heide, Palliat Med 2014 28:9, 2014, Vol. 28(8) 1000–1025. Published online before print 20 March 2014, DOI: 10.1177/0269216314526272.

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Links and resources…

ACTION (Advance Care Planning – An Innovative Palliative Care Intervention to Improve Quality of Life in Oncology).
The EAPC is currently preparing a new White Paper on Advance Care Planning. Check the EAPC website and social media links for future updates.