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dc.contributor.authorJimenez, Geronimoen
dc.contributor.authorTan, Woan Shinen
dc.contributor.authorVirk, Amrit K.en
dc.contributor.authorLow, Chan Keeen
dc.contributor.authorCar, Josipen
dc.contributor.authorHo, Andy Hau Yanen
dc.identifier.citationJimenez, G., Tan, W. S., Virk, A. K., Low, C. K., Car, J., & Ho, A. H. Y. (2018). Overview of systematic reviews of advance care planning : summary of evidence and global lessons. Journal of Pain and Symptom Management, 56(3), 436-459. doi:10.1016/j.jpainsymman.2018.05.016en
dc.description.abstractBackground: Advance care planning (ACP) involves important decision making about future medical needs. The high-volume and disparate nature of ACP research makes it difficult to grasp the evidence and derive clear policy lessons for policymakers and clinicians. Aim: The aim of this study was to synthesize ACP research evidence and identify relevant contextual elements, program features, implementation principles, and impacted outcomes to inform policy and practice. Design: An overview of systematic reviews using the Cochrane Handbook of Systematic Reviews of Interventions was performed. Study quality was assessed using a modified version of the AMSTAR (A MeaSurement Tool to Assess Reviews) tool. Data Sources: MEDLINE, EBM Reviews, Cochrane Reviews, CINAHL, Global Health, PsycINFO, and EMBASE were searched for ACP-related research from inception of each database to April 2017. Searches were supplemented with gray literature and manual searches. Eighty systematic reviews, covering over 1660 original articles, were included in the analysis. Results: Legislations, institutional policies, and cultural factors influence ACP development. Positive perceptions toward ACP do not necessarily translate into more end-of-life conversations. Many factors related to patients' and providers' attitudes, and perceptions toward life and mortality influence ACP implementation, decision making, and completion. Limited, low-quality evidence points to several ACP benefits, such as improved end-of-life communication, documentation of care preferences, dying in preferred place, and health care savings. Recurring features that make ACP programs effective include repeated and interactive discussion sessions, decision aids, and interventions targeting multiple stakeholders. Conclusions: Preliminary evidence highlights several elements that influence the ACP process and provides a variety of features that could support successful, effective, and sustainable ACP implementation. However, this evidence is compartmentalized and limited. Further studies evaluating ACP as a unified program and assessing the impact of ACP for different populations, settings, and contexts are needed to develop programs that are able to unleash ACP's full potential.en
dc.description.sponsorshipMOH (Min. of Health, S’pore)en
dc.format.extent49 p.en
dc.relation.ispartofseriesJournal of Pain and Symptom Managementen
dc.rights© 2018 The Author(s). Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine. This is an open access article under the CC BY-NC-ND license (
dc.subjectEnd-of-life Careen
dc.subjectAdvance Care planningen
dc.titleOverview of systematic reviews of advance care planning : summary of evidence and global lessonsen
dc.typeJournal Articleen
dc.contributor.schoolSchool of Social Sciencesen
dc.contributor.schoolInterdisciplinary Graduate School (IGS)en
dc.contributor.schoolLee Kong Chian School of Medicine (LKCMedicine)en
dc.contributor.organizationNTU Institute for Health Technologiesen
dc.description.versionPublished versionen
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