Communicative practices used by health and social care professionals, older adults and informal carers during advance care planning conversations: systematic review of qualitative evidence and narrative synthesis.

Abstract

Background: While advance care planning (ACP) is linked with clinical and psychosocial benefits for older adults and their informal carers, uptake is low. Inadequate communication skills amongst clinicians has been identified as a key barrier to effective ACP. While existing literature reviews have focussed on hypothetical preferences, barriers and facilitators, none have examined direct experience of ACP communication with this population. The aim of this review was to identify and synthesise qualitative evidence regarding the communicative practices used to support older adults, informal carers and health and social care professionals (HSCPs) have ACP conversations.

Methods: A systematic review of qualitative evidence and narrative synthesis were undertaken. Five electronic databases (Medline, CINAHL, Emcare, Embase, PsychInfo) were systematically searched from inception to August 2024 for eligible studies reporting on features of ACP communication between HSCPs, older adults and informal carers. Quality appraisal was completed, with thematic analysis used to synthesise findings from eligible studies.

Findings: From 6348 titles identified, 264 full texts were assessed for eligibility. Twenty-eight articles reporting on 25 studies were included in the narrative synthesis. Four analytical themes were generated: (i) Introducing a delicate topic; (ii) Participation within the care triad; (iii) Professional influence in decision-making; (iv) Patient perspectives on planning and care.

Conclusions: ACP conversations would benefit from improved, personalised information provision to support informed decision-making, with clear, compassionate communication facilitated by continuity of care. Future research should further examine the role of informal carers, nonverbal communication, and take a broader view of ACP as an interactional process.