Impact of Advance Care Planning Interventions on Patient and Family Satisfaction: A Systematic Review and Descriptive Analysis (S777)

Abstract

•Discuss the types of interventions used to support high quality advance care planning.•Recognize the impact of advance care planning on patient and family satisfaction. Patient satisfaction has been used to evaluate the quality of end-of-life (EOL) care, and is an increasingly used metric to measure provider performance and reimbursement. The objective of this systematic review and descriptive analysis was to determine the impact of advance care planning (ACP) interventions on patient and family satisfaction. All prospective and retrospective clinical trials in adults and pediatric populations with an ACP intervention, and a measured outcome of patient and/or family satisfaction. Studies were grouped by type of ACP intervention, and the impact of the interventions on patient and family satisfaction was described for each type. Of 487 citations, 11 trials met inclusion criteria. ACP interventions were categorized as follows: self-directed completion of AD (1 study), self-directed ACP web-based or video education tools (2), and facilitated ACP discussion with trained facilitators (8). Study participants included general elderly (6) or pediatric populations (1) and specific populations including cancer (1), HIV/AIDS (1), teenagers with cancer (1) and dementia (1). Certain studies were based in specific care settings, including nursing homes (2), primary care clinics (1), palliative care units (3) and acute care (1). Self-directed ACP showed a trend toward increased patient satisfaction. The use of ACP video and web-based tools was associated with increased patient satisfaction. Six of the 8 studies of facilitated ACP conversations showed increased patient satisfaction. Several studies also demonstrated improvement in anxiety and depression symptoms, and increased completion rates of advance directive documents in ACP intervention groups. Families were generally more satisfied with EOL care when an AD was in place. Patient and family satisfaction increased with a variety of ACP interventions, supporting the use of ACP in high quality EOL care. These data may also support a business plan for ACP programs, given the implications for provider reimbursement.