Question:
In adults with dementia, what aspects of advanced care planning are effective in improving patient outcomes?
Answer:
Plain language summary
More high quality research is needed to explore the effects of
different advanced care planning interventions, and to determine
which aspects of these interventions are effective, in adults with
dementia.
Clinical and research implications
There is currently insufficient evidence to adequately assess
the effects of Advanced Care Planning (ACP) interventions for
people with dementia. All of the available evidence relates to
education and training programs delivered in nursing homes and
involving either staff alone, or staff, residents and family
members. The characteristics of the nursing home residents in these
studies are poorly described, with only one study specifically
mentioning people with dementia. The very limited evidence
available suggests that ACP interventions may have some effect in
increasing ACP-related outcomes (e.g. number of 'Do Not
Resuscitate' orders and documentation of residents' preferences in
relation to specific treatments), however, these effects are
inconsistent and often not statistically significant. There is also
some limited evidence to suggest that ACP interventions may be
associated with reduced hospitalisation rates. All of the available
evidence describes the effects of ACP interventions in comparison
to usual care.
High quality studies, preferably using participant level
randomisation, are needed to adequately explore the effects of
different ACP interventions in people with dementia. It is
important to specify the clinical characteristics of patients
included in such studies, as the level of cognitive impairment is
likely to be an important modulator of the effectiveness of ACP
interventions.
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