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
Professor Fliss Murtagh F.Murtagh@hull.ac.uk
Professor of Palliative Care
Professor Miriam Johnson Miriam.Johnson@hull.ac.uk
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
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).
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.
|Publication Date||Dec 1, 2018|
|Peer Reviewed||Peer Reviewed|
|APA6 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|
|Keywords||Heart failure; Advance care planning; Hospitalisation; Palliative|
|Copyright Statement||Copyright © 2018 The authors. Reprinted by permission of SAGE Publications|
Copyright © 2018 The authors. Reprinted by permission of SAGE Publications