Evidence map›Paper›PMID 25679395›Full record

SynthesisPloS one2015

Barriers to advance care planning at the end of life: an explanatory systematic review of implementation studies.

Susi Lund, Alison Richardson, Carl May

Registry-linked trialAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in PloS one, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05681585 (Implementing Advanced Care Planning in the Routine Care for Acutely Admitted Patients in Geriatric Units), which is not on this map. Cited by 142 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
142citing papers in PubMed, 10 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05681585 narecruitingnot on this mapstarted 2023, after this paper: background citation

Implementing Advanced Care Planning in the Routine Care for Acutely Admitted Patients in Geriatric Units: a Cluster Randomised Controlled Trial

TypeinterventionalSponsorUniversity of OsloRan2023 to 2026Enrolled2,000ConditionsAdvance Care PlanningArmsImplementation support program
3 · Its place in the literature

Who cites it

142 citing papers in PubMed, 10 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Pooled it
  9. Pooled it
  10. Pooled it
  11. Trial
  12. Feasibility and Acceptability of Facilitated Advance Care Planning in Outpatient Clinics: A Qualitative Study of Patient and Caregivers Experiences.Journal of applied gerontology : the official journal of the Southern Gerontological Society · 2024
    Trial
  13. Trial
  14. Primary Palliative Care Improves Uptake of Advance Care Planning Among Patients With Advanced Cancers.Journal of the National Comprehensive Cancer Network : JNCCN · 2023
    Trial
  15. Trial
  16. Trial
  17. Trial
  18. Article
  19. Article
  20. Article

82 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors.

Susi LundFaculty of Health Sciences, University of Southampton, Southampton, United Kingdom; Royal Berkshire NHS Foundation Trust, Reading, United Kingdom.
Alison RichardsonFaculty of Health Sciences, University of Southampton, Southampton, United Kingdom; University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; National Institute for Health Research Collaboration for Leadership in Applied Research and Care Wessex, Southampton, United Kingdom.
Carl MayFaculty of Health Sciences, University of Southampton, Southampton, United Kingdom; University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; National Institute for Health Research Collaboration for Leadership in Applied Research and Care Wessex, Southampton, United Kingdom.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

contextAdvance Care Plans (ACPs) enable patients to discuss and negotiate their preferences for the future including treatment options at the end of life. Their implementation poses significant challenges.

objectiveTo investigate barriers and facilitators to the implementation of ACPs, focusing on their workability and integration in clinical practice.

designAn explanatory systematic review of qualitative implementation studies. DATA SOURCES: Empirical studies that reported interventions designed to support ACP in healthcare. Web of Knowledge, Ovid MEDLINE, CINAHL, PsycINFO, British Nursing Index and PubMed databases were searched.

methodsDirect content analysis, using Normalization Process Theory, to identify and characterise relevant components of implementation processes.

results13 papers identified from 166 abstracts were included in the review. Key factors facilitating implementation were: specially prepared staff utilizing a structured approach to interactions around ACPs. Barriers to implementation were competing demands of other work, the emotional and interactional nature of patient-professional interactions around ACPs, problems in sharing decisions and preferences within and between healthcare organizations.

conclusionsThis review demonstrates that doing more of the things that facilitate delivery of ACPs will not reduce the effects of those things that undermine them. Structured tools are only likely to be partially effective and the creation of a specialist cadre of ACP facilitators is unlikely to be a sustainable solution. The findings underscore both the challenge and need to find ways to routinely incorporate ACPs in clinical settings where multiple and competing demands impact on practice. Interventions most likely to meet with success are those that make elements of Advance Care Planning workable within complex and time pressured clinical workflows.

Indexed as

Advance Care PlanningHumansTerminal Care

Identifiers

PMID25679395
PMCPMC4334528

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.