Simon Oczkowski|Harold M. Chung|Louise Hanvey|Lawrence Mbuagbaw|John J. You
Communication Tools for End-of-Life Decision-Making in Ambulatory Care Settings: A Systematic Review and Meta-Analysis
McMaster University|McMaster University|Canadian Hospice Palliative Care Association|St. Joseph’s Healthcare Hamilton|McMaster University|McMaster University
patients serious illness families state better communication decisionmaking healthcare providers high priority improve quality endoflife care numerous communication tools assist patients family members clinicians endoflife decisionmaking published effectiveness remains unclearto determine amongst adults ambulatory care settings effect structured communication tools endoflife decisionmaking completion advance care planningwe searched relevant randomized controlled trials rcts nonrandomized intervention studies medline embase cinahl eric cochrane database randomized controlled trials database inception july 2014 two reviewers independently screened articles eligibility extracted data assessed risk bias grading recommendations assessment development evaluation grade used evaluate quality evidence primary secondary outcomessixtyseven studies including 46 rcts found majority evaluated communication tools older patients age 50 specific medical condition many specifically evaluated populations cancer lung heart neurologic renal disease studies compared use communication tools usual care several compared tools lessintensive advance care planning tools use structured communication tools increased frequency advance care planning discussionsdiscussions advance directives rr 231 95 ci 125426 p 0007 low quality evidence completion advance directives ads rr 192 95 ci 143259 p0001 low quality evidence concordance ad preferences subsequent medical orders use nonuse life supporting treatment rr 119 95 ci 101139 p 0028 low quality evidence 1 observational study concordance care desired care received patients rr 117 95 ci 105130 p 0004 low quality evidence 2 rctsthe use structured communication tools may increase frequency discussions completion advance directives concordance care desired care received patients use structured communication tools rather adhoc approach endoflife decisionmaking considered selection implementation tools tailored address local needs contextprospero crd42014012913