Exploring older people's end-of-life care preferences over time: A scoping review.

Abstract

Background: Understanding the evolution of end-of-life preferences over time is important for dynamic, person-centred palliative care. This is particularly relevant for older people whose preferences can be incompletely expressed and subject to change.

Aim: To summarise the nature of the current evidence about how and why the end-of-life preferences of older people change over time.

Design: A scoping review was performed, using a predefined protocol and following the JBI manual for evidence synthesis.

Data sources: Final searches of Medline, Embase, PsycINFO and Web of Science were carried out in October 2023. Reference lists were also reviewed. Eligibility criteria included studies recruiting people over the age of 60 that explored how or why end-of-life preferences developed over time.

Results: Screening identified 52 articles, reporting on 40 studies. A majority were longitudinal studies collecting quantitative data about treatment preferences. Other preference categories included euthanasia, balancing quality and length of life, goals of care, preferred place of death, decision-making and spiritual preferences. Studies explored a variety of factors that may influence preference change or stability. There was a lack of research with ethnic minority groups and people aged over 80.

Conclusions: Existing research has focused on preferences about specific therapies, at the expense of understanding what matters most to older people. Synthesis of the available evidence about why preferences change will guide reviews of patients' advance care plans. To inform dynamic, person-centred end-of-life care we need studies prospectively exploring how older people construct a broader range of preferences, and negotiate these over time.