Does advance care planning in addition to usual care reduce hospitalisation for patients with advanced heart failure: A systematic review and narrative synthesis

Kernick, Lucy; Hogg, Karen; Millerick, Yvonne; Murtagh, Fliss; Djahit, Ayse; Johnson, Miriam

Abstract

BACKGROUND: People with advanced heart failure have repeated hospital admissions. Advance care planning can support patient preferences, but studies in people with heart failure have not been assessed.
AIM: To evaluate the literature regarding advance care planning and hospitalisation in heart failure.
DESIGN: Systematic review and narrative analysis.(PROSPERO
CRD42017059190)
DATA SOURCES: Electronic databases were searched (1990 to
23.03.2017); MEDLINE(R), Cochrane Library, CINAHL, and Scopus. Four journals were hand searched. Two independent researchers screened against eligibility criteria. One reviewer extracted all data and a sample by a second. Quality was assessed by Cochrane Risk of Bias or the Critical Appraisal Skills Programme Tool for Cohort Studies.
RESULTS: 8/1713 articles were included representing 14,357 participants from in/outpatient settings from five countries. Two randomised-controlled trials and one observational study assessed planning as part of a specialist palliative care intervention; one randomised-controlled trial assessed planning in addition to usual cardiology care; one randomised-controlled trial and one observational study assessed planning in an integrated cardiology-palliative care model; one observational study assessed evidence of planning (advance directive) as part of usual care, and one observational study was a secondary analysis of trial participants coded Do Not Attempt Cardiopulmonary Resuscitation. Advance care planning i) reduced hospitalisation(5/7 studies), ii) increased referral/use of palliative services (4/4 studies), iii) supported deaths in the patient-preferred place (2/2 studies).
CONCLUSIONS:
Advance care planning as part of a specialist palliative care care
intervention reduces hospitalisation. Preliminary studies of planning integrated into generic care, accessing specialist palliative care support if needed, are promising.

Citation

Kernick, L., Hogg, K., Millerick, Y., Murtagh, F., Djahit, A., & Johnson, M. (2018). Does advance care planning in addition to usual care reduce hospitalisation for patients with advanced heart failure: A systematic review and narrative synthesis. Palliative medicine, 32(10), 1539-1551. https://doi.org/10.1177/0269216318801162

• Journal Article Type: Article
• Acceptance Date: Aug 23, 2018
• Online Publication Date: Sep 20, 2018
• Publication Date: Dec 1, 2018
• Deposit Date: Aug 30, 2018
• Publicly Available Date: Sep 3, 2018
• Journal: Palliative medicine
• Print ISSN: 0269-2163
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• Volume: 32
• Issue: 10
• Pages: 1539-1551
• DOI: https://doi.org/10.1177/0269216318801162
• Keywords: Heart failure; Advance care planning; Hospitalisation; Palliative
• Public URL: https://hull-repository.worktribe.com/output/1006542
• Publisher URL: https://journals.sagepub.com/doi/full/10.1177/0269216318801162
• Contract Date: Sep 3, 2018