Evidence map›Paper›PMID 40598130›Full record

SynthesisBMC palliative care2025

Using nudges with electronic health records systems to improve advance care planning: a systematic review.

Tong Zhu, Rongqing Wu, Jiangxue Wu, Rick Yiu Cho Kwan, Ming Liu, Aiting Zhou, Renli Deng

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC palliative care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
  4. Article
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

7 authors.

Tong ZhuNursing Department, The Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Huichuan District, Zunyi, 563099, Guizhou Province, China.
Rongqing WuNursing Department, The Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Huichuan District, Zunyi, 563099, Guizhou Province, China.
Jiangxue WuNursing Department, The Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Huichuan District, Zunyi, 563099, Guizhou Province, China.
Rick Yiu Cho KwanSchool of Nursing, Tung Wah College, Hong Kong SAR, China.
Ming LiuPeking University Health Science Centre-Macao Polytechnic University, Macao, SAR, China.
Aiting ZhouNursing Department, The Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Huichuan District, Zunyi, 563099, Guizhou Province, China.
Renli DengNursing Department, The Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Huichuan District, Zunyi, 563099, Guizhou Province, China. 690891192@qq.com.

Funding

Guizhou Provincial Science and Technology Program Qiankehe Platform Talent-CXTD [2023]028National Natural Science Foundation of China 72274235Zunyi Science and Technology Program Zun Shi Ke He HZ Zi (2022) 338
6 · The paper itself

Abstract

backgroundResearchers are increasingly studying nudges as a theoretical approach to promote behavior change. With the advancement of technology, nudges with electronic health records (EHR) systems become a new way to encourage healthcare professionals to perform advance care planning (ACP). This review aims to summarize nudges with EHR interventions and assess their effects on ACP outcomes.

methodsA comprehensive search was conducted in Scopus, CINAHL, Web of Science, PubMed, and Embase for randomized controlled trials (RCTs) published up to December 2024. Studies were included if they employed nudges developed within the EHR environment in healthcare setting and reported at least one objective measure of ACP. Two reviewers screened the titles, abstracts, and full texts and extracted data. Risk of bias was assessed using the Cochrane Risk of Bias Tool 2.0. A narrative synthesis was conducted for the data.

resultsTen reports (nine studies), including 27,556 participants, met all of the inclusion criteria. Nudge interventions included both EHR-delivered nudges and non-EHR nudges. Using the MINDSPACE framework, the EHR-delivered nudges were categorized as priming (n = 10), salience/affect (n = 1), and default (n = 1). The non-EHR nudges were classified as priming (n = 5), salience/affect (n = 2), and norms and messenger (n = 1). Narrative synthesis showed consistently positive effects on ACP documentation, serious illness conversations documentation, prognosis communication, advance directive completion, and goals-of-care documentation. Most studies reported statistically significant improvements. In contrast, the effects of interventions on end-of-life outcomes were inconsistent and largely non-significant.

conclusionOverall, findings suggest that EHR-integrated nudge strategies may improve documentation and communication practices related to ACP in patients with serious illness. However, their impact on downstream clinical outcomes remains uncertain. Due to the limited number of studies and high heterogeneity, further research is needed to validate these findings.

Indexed as

Advance Care PlanningElectronic Health RecordsHumansAdvance care planningElectronic health recordsGoals of care discussionsNudgesSerious illness conversationsSystematic review.

Identifiers

PMID40598130
PMCPMC12220458

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

None linked

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.