Effects of advance care planning for patients with advanced cancer: A meta-analysis of randomized controlled studies

Abstract

Background

Patients with advanced cancer often have to make difficult end-of-life decisions, which are closely associated with their access to anticipated care after loss of mental capacity. Advance care planning, an approach of discussing, documenting, and deciding on end-of-life preferences, helps with better decision-making. However, despite being recommended for oncology care, its efficacy for patients with advanced cancer remains unclear.

Objective

To explore the effects of advance care planning in patients with advanced cancer.

Design

Systematic review and meta-analysis.

Methods

Twelve electronic databases, including Embase, Medline, the Cochrane Central Register of Controlled Trials, PsycINFO, Web of Science, CINAHL complete, CBM, CNKI, VIP, Wanfang, Google Scholar and Proguest Dissertations and Theses, were searched from inception to December 2024. The Cochrane Risk of Bias Tool 2.0 was used to evaluate the quality of the included studies. Meta-analysis was performed with R software, and outcomes not amenable to meta-analysis were narratively synthesized.

Results

Fourteen studies were included. The results of the meta-analysis implied that advance care planning significantly improved the completion of advance directives (OR = 7.93, 95 % CI: 2.76–22.77, P = 0.0001) and palliative care utilization (OR = 1.39, 95 % CI: 1.08–1.78, P = 0.0009). Anxiety (SMD = − 0.14, 95 % CI: − 0.52–0.23, P = 0.45), depression (SMD = − 0.10, 95 % CI: − 0.55–0.34, P = 0.66), decisional conflicts (MD = − 1.25, 95 % CI: − 3.67–1.18, P = 0.31), patient satisfaction (SMD = 0.19, 95 % CI: − 0.23–0.70, P = 0.47), and quality of life (SMD = 0.32, 95 % CI: − 0.83–1.48, P = 0.58) were not improved. In the narrative synthesis, dignity was enhanced, but the effects of concordance between actual care received and preferences were inconsistent. In general, existing advance care planning is primarily delivered in a face-to-face format in hospitals and focuses on older patients.

Conclusions

Advance care planning may have desirable impacts on improving the completion of advance directives and palliative care utilization for patients with advanced cancer. It was not effective in improving anxiety, depression, decisional conflicts, patient satisfaction, and quality of life. The effects of dignity and care concordance need to be further validated. Young patient-specific, digital technology-based, and in-home advance care planning is encouraged, and the optimal timing of interventions also needs to be clarified.