Advance Care Planning in Asia: A Systematic Narrative Review of Healthcare Professionals’ Knowledge, Attitude, and Experience

Diah Martina,Cheng-Pei Lin,Martina S Kristanti,Wichor M Bramer,Masanori Mori,Ida J Korfage,Agnes Van Der Heide,Carin C.D Van Der Rijt,Judith A.C Rietjens

doi:10.1016/j.jamda.2020.12.018

Abstract

ObjectiveThe value of advance care planning (ACP) for patients with life-limiting illnesses is widely recognized but Asian health care professionals' (HCPs') perspectives on ACP have received little systematic attention. We aim to synthesize evidence regarding Asian HCPs’ knowledge of, attitudes toward, and experiences with ACP. DesignSystematic review with narrative synthesis and stepwise thematic analysis. Setting and ParticipantsHCPs in southern, eastern, and southeastern Asia. MethodsStudies from inception to September 2019 were identified from English-language searches of Embase, MEDLINE, Web of Science, and Google Scholar with reference-chaining and hand-searching. Two investigators independently screened and assessed the risk of bias in all original studies reporting HCPs’ knowledge of, attitudes toward, and experiences with ACP, including their perspectives toward barriers and facilitators of ACP. ResultsFifty-one studies were included; 42 were quantitative, 43 had been conducted in high-income countries, and 36 were of good quality. Twenty-six studies operationalized ACP as the completion of an advance directive rather than a value-exploration process. Thirteen studies reported knowledge, 44 attitudes, 29 experiences, and 36 barriers and facilitators of ACP. Asian HCPs addressed the essential role of families in ACP. They acknowledge the importance of ACP but rarely engage the patient in it. They considered ACP difficult to initiate, partly because of their lack of knowledge and skills in ACP, personal uneasiness to conduct ACP, fear of conflicts with family members and their legal consequences, and the lack of a standard system for ACP. Most studies indicated HCPs’ low engagement and late initiation of ACP. Conclusions and ImplicationsDespite acknowledging its importance, Asian HCPs felt that engaging in ACP is challenging. Capacity building for ACP in Asia should focus on culturally adapting ACP models concerning the essential role of the family in Asia, education for HCPs and the public, and providing institutional support for ACP.

Highlights

The term advance care planning (ACP) was used in 12 studies that had been published in the last decade (Tables 1 and 2)
With regard to the role of family, our findings showed that Asian health care professionals’ (HCPs) often engaged family in ACP without the patient
Its uptake in Asia may be improved by adapting the current ACP models to acknowledge the deep importance traditionally attached to the role of the family

Summary

Objectives

Protocol and registrationEligibility criteria (eg, years considered, language, publication status) used as criteria for eligibility, giving rationale.Information sources Search Study selectionData collection process10 Describe method of data extraction from reports (eg, piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators. Eligibility criteria (eg, years considered, language, publication status) used as criteria for eligibility, giving rationale. Describe method of data extraction from reports (eg, piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators. List and define all variables for which data were sought (eg, PICOS, funding sources) and any assumptions and simplifications made. Risk of bias in individual studies 12 Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis

Methods

Results

Discussion

Conclusion