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BMJ Support Palliat Care. 2019 Feb 26. pii: bmjspcare-2018-001680. doi: 10.1136/bmjspcare-2018-001680. [Epub ahead of print]

Advance care planning for home health staff: a systematic review.

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Palliative Medicine, Ysbyty Ystrad Fawr, Newport, UK
Division of Population Medicine, Cardiff University, Cardiff, UK.
University Library Service, Cardiff University, Cardiff, UK.



Advance care planning (ACP) is a process where patients express their wishes regarding their future healthcare. Its importance has been increasingly recognised in the past decade. As increasing numbers of elderly people are living in care homes, the aim of this review was to identify the most effective ACP interventions to train/educate all levels of healthcare professionals working in care homes.


A systematic review. Two independent reviewers undertook screening, data extraction and quality assessment.


 Searched from inception to June 2018: Ovid Medline, Ovid Medline in process, Ovid Embase, Cochrane Central Register of Controlled Trials, EBSCO Cinahl and Ovid PsycINFO.


Six studies were included: three before and after studies, one cluster randomised controlled trial (RCT), one non-blinded RCT and one qualitative study. Five studies reported on ACP documentation, three on impact on ACP practice and three studies on healthcare-related outcomes. All quantitative studies reported an improvement in outcomes. In the three studies reporting on health-related outcomes, one showed significant reductions in hospitalisation rate, days and healthcare costs; one reported significant reductions in hospital deaths; and the third showed reductions in hospital days and deaths. A meta-analysis could not be performed due to the heterogeneity of the outcome measures. The included qualitative study highlighted perceived challenges to implementing an educational programme in the care home setting.


There is limited evidence for the effectiveness of ACP training for care home workers. More well-designed studies are needed.




advance care planning; clinical decisions; education; nursing homes; terminal care

Conflict of interest statement

Competing interests: None declared.

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