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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