SynthesisAge and ageing2026
Enhancing goals of care discussions: a systematic review and meta-analysis of clinician-directed behavioural nudges.
Synthesis in Age and ageing, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundGoals of care discussions (GOCDs) are critical for patients with serious illnesses but are hindered by clinician-level barriers. Nudges-low-burden, behaviourally informed strategies that influence clinician behaviour without restricting choice-may provide a scalable approach to increase GOCDs. We systematically reviewed and meta-analysed the effect of clinician-directed nudges on GOCD documentation. Secondary outcomes were quality of communication and healthcare utilisation.
methodsWe searched three databases (2004-2024). Nudges were classified using the MINDSPACE framework. Random-effects meta-analysis estimated pooled odds ratios (ORs) with 95% confidence intervals (CIs) for GOCD documentation. Subgroup analyses examined nudge type, study design and co-interventions. Secondary outcomes were narratively synthesised.
resultsFifty-one studies were included (16 randomised trials, 7 non-randomised controlled studies and 28 pre-post studies). Salience-based nudges, which make key information more noticeable, were most common (86% of interventions). Most interventions (87%) were multicomponent. Nudges increased GOCD documentation (OR 3.30, 95% CI 2.40-4.53). Multicomponent interventions with a nudge component had larger effects than nudges alone (OR 4.03 vs. 1.89; P = .03). No differences were observed by nudge types or study designs. Heterogeneity was high (I2 = 96.7%) but leave-one-out sensitivity analyses supported robustness. Nudges improved quality of communication (2/2 studies) and reduced readmissions (2/2), with inconsistent effects on palliative care referrals (5/19) and no impact on hospital length of stay (0/5).
conclusionClinician-directed nudges improve GOCD documentation and represent a scalable, low-cost strategy for quality improvement. Future research should examine a broader range of nudges, multilevel interventions and effects on the quality and timing of GOCDs across settings.
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