The Effect of Advance Care Planning Intervention on Hospitalization Among Nursing Home Residents: A Systematic Review and Meta-Analysis

Apiradee Pimsen; Chi-Yin Kao; Sheng-Tzu Hsu; Bih-Ching Shu

doi:10.1016/j.jamda.2022.07.017

The Effect of Advance Care Planning Intervention on Hospitalization Among Nursing Home Residents: A Systematic Review and Meta-Analysis

J Am Med Dir Assoc. 2022 Sep;23(9):1448-1460.e1. doi: 10.1016/j.jamda.2022.07.017. Epub 2022 Aug 11.

Authors

Apiradee Pimsen¹, Chi-Yin Kao², Sheng-Tzu Hsu³, Bih-Ching Shu⁴

Affiliations

¹ Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC; Faculty of Nursing, Mahidol University, Bangkok, Thailand. Electronic address: apiradee.pim@mahidol.edu.
² Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC. Electronic address: chiyinkao@mail.ncku.edu.tw.
³ Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC; Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan, ROC.
⁴ Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC; Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC. Electronic address: shubih@ncku.edu.tw.

PMID: 35964662
DOI: 10.1016/j.jamda.2022.07.017

Abstract

Objective: To evaluate the effect of advance care planning (ACP) interventions on the hospitalization of nursing home residents.

Design: Systematic review and meta-analysis.

Setting and participants: Nursing homes and nursing home residents.

Methods: A literature search was systematically conducted in 6 electronic databases (Embase, Ovid MEDLINE, Cochrane Library, CINAHL, AgeLine, and the Psychology & Behavioral Sciences Collection), in addition to hand searches and reference list checking; the articles retrieved were those published from 1990 to November 2021. The eligible studies were randomized controlled trials, controlled trials, and pre-post intervention studies describing original data on the effect of ACP on hospitalization of nursing home residents; these studies had to be written in English. Two independent reviewers appraised the quality of the studies and extracted the relevant data using the Joanna Briggs Institute abstraction form and critical appraisal tools. A study protocol was registered in PROSPERO (CRD42022301648).

Results: The initial search yielded 744 studies. Nine studies involving a total of 57,180 residents were included in the review. The findings showed that the ACP reduced the likelihood of hospitalization [relative risk (RR) 0.54, 95% CI 0.47-0.63; I² = 0%)], it had no effect on emergency department (ED) visits (RR 0.60, 95% CI 0.31-1.42; I² = 99), hospice enrollment (RR 0.98, 95% CI 0.88-1.10; I² = 0%), mortality (RR 0.83, 95% CI 0.68-1.00; I² = 4%), and satisfaction with care (standardized mean difference: -0.04, 95% CI -0.14 to -0.06; I² = 0%).

Conclusion and implications: ACP reduced hospitalizations but did not affect the secondary outcomes, namely, ED visits, hospice enrollment, mortality, and satisfaction with care. These findings suggest that policy makers should support the implementation of ACP programs in nursing homes. More robust studies are needed to determine the effects of ACP on ED visits, hospice enrollment, mortality, and satisfaction with care.

Keywords: Advance care planning; hospitalization; nursing home residents.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Advance Care Planning*
Emergency Service, Hospital
Hospice Care*
Hospitalization
Humans
Nursing Homes