Situation, Education, Innovation, and Recommendation: A Large-Scale Systematic Review of Advance Care Planning in the Age of COVID-19
Abstract
:1. Introduction
2. Materials and Methods
2.1. Protocol and Registration
2.2. Information Sources
2.3. Study Selection
2.4. Data Extraction
2.5. Quality Appraisal
3. Results
3.1. Overview of the Results
3.2. ACP Barriers and Facilitators during the COVID-19 Pandemic
3.2.1. Situation Category
Study ID | Country | Setting | Population | Number of Participants | Quality Assessment | ACP Barriers and Facilitators |
---|---|---|---|---|---|---|
Mota Romero 2022 [35] | SP | NH | HP | 20 | ■ | Barriers: Lack of awareness/knowledge of ACP |
Statler 2022 [36] | US | HO | PT | 356 | ■ | Barriers: Legal concerns; Uncertainty surrounding the COVID-19 prognosis; Limited resources; Healthcare system barriers; Discomfort among clinicians and patients discussing end-of-life care Facilitators: Resources/education for patients/families; Proactive ACP conversations; Telehealth/virtual ACP platforms; Identification of those in need of ACP |
Porteny 2022 [37] | US | HO | PT | 76 | ■ | Barriers: Social distancing measures and visitation restrictions Facilitators: Telehealth/virtual ACP platforms |
Epler 2022 [38] | US | HO | PT | 720 | ■ | Barriers: Discomfort among clinicians and patients discussing end-of-life care; Familial disagreement; Time constraints; Rapid disease progression |
Kaehr 2022 * [39] | US | NH | HP | 17 | ■ | Barriers: Personal protective equipment requirements; Social distancing measures and visitation restrictions; Uncertainty surrounding the COVID-19 prognosis |
Sun 2022 [40] | US | HO | PT | 276 | ■ | Barriers: Social distancing measures and visitation restrictions; Personal protective equipment requirements; Strained healthcare system; Uncertainty surrounding the COVID-19 prognosis Facilitators: Identification of those in need of ACP |
Barnato 2022 [41] | US | ED | PT | 5394 | ■ | Facilitators: Diagnosis of dementia |
Ter Brugge 2022 [42] | NL | NH | HP | 127 | ■ | Barriers: Social distancing measures and visitation restrictions Facilitators: Understanding/fear of COVID-19; Telehealth/virtual ACP platforms; Public awareness of ACP |
Perumalswami 2022 [43] | US | HO | HP | 22 | ■ | Barriers: Technological/telehealth barriers |
Jayes 2022 [44] | UK | HO, NH | HP | 107 | ■ | Barriers: Social distancing measures and visitation restrictions; Personal protective equipment requirements; Time constraints |
Janssen 2021 [45] | NL | HO | PT | ■ | Barriers: Uncertainty surrounding the COVID-19 prognosis; Time constraints; Negative perceptions about advance care planning Facilitators: Public awareness of ACP; Telehealth/virtual ACP platforms; Training for clinicians; Guidance and protocols for ACP discussions; Care team collaboration | |
Brophy 2021 [46] | US | SV | PB | 522 | ■ | Barriers: Emotional barriers Facilitators: Understanding/fear of COVID-19 |
Piers 2021 [47] | BL | HO | PT | 711 | ■ | Facilitators: ACP/palliative care experts: co-management by geriatricians |
Bradshaw 2021 [48] | UK | NH | HP | 277 | ■ | Barriers: Social distancing measures and visitation restrictions; Personal protective equipment requirements; Strained healthcare system; Rapid disease progression; Emotional barriers; Uncertainty surrounding the COVID-19 prognosis Facilitators: Innovation and flexibility in ACP documentation processes; Public awareness of ACP; Telehealth/virtual ACP platforms; Care team collaboration; ACP/palliative care experts; Training for clinicians |
Dujardin 2021 [49] | NL | HO | HP | 15 | ■ | Barriers: Uncertainty surrounding the COVID-19 prognosis; Discomfort among clinicians and patients discussing end-of-life care; Technological/telehealth barriers; Social distancing measures and visitation restrictions; Time constraints; Healthcare system barriers Facilitators: Trusting clinical relationship; Telehealth/virtual ACP platforms; Healthcare system improvements |
Connellan 2021 [50] | IR | ED | PT | 430 | ■ | Facilitators: Understanding/fear of COVID-19 |
Vellani 2021 [51] | CN | NH | HP | 14 | ■ | Facilitators: ACP/palliative care experts; Telehealth/virtual ACP platforms; Care team collaboration; Proactive ACP Conversations |
Toccafondi 2021 * [52] | IT | HO | PT | 110 | ■ | Facilitators: Guidance and protocols for ACP discussions |
DeGette 2021 * [53] | US | HO | PT | 258 | ■ | Barriers: Personal protective equipment requirements; Social distancing measures and visitation restrictions; Uncertainty surrounding the COVID-19 prognosis; Racial and ethnic barriers Facilitators: Identification of those in need of ACP |
Copley 2021 [54] | UK | HO | PT | 164 | ■ | Facilitators: Resources for clinicians; Understanding/fear of COVID-19; Public awareness of ACP; Resources/education for patients/families |
Lin 2021 [55] | TW | HO | PT | 2493 | ■ | Barriers: Social distancing measures and visitation restrictions; Lack of awareness/knowledge of ACP; Healthcare system barriers; Limited resources; Legal concerns; Discomfort among clinician and patients discussing end-of-life care; Time constraints; Strained healthcare system Facilitators: Telehealth/virtual ACP platforms |
Ye 2021 [56] | US | NH | PT | 963 | ■ | Barriers: Social distancing measures and visitation restrictions Facilitators: Proactive ACP conversations |
Huayanay 2021 [57] | US | HO | PT | 1 | ■ | Barriers: Communication difficulties; Cultural and religious beliefs; Financial concerns |
Nguyen 2021 [58] | US | SV | PT | 100 | ■ | Facilitators: Public awareness of ACP; Improved messaging |
Coles 2020 * [59] | UK | NH | HP | ■ | Facilitators: Care team collaboration; ACP/palliative care experts; Healthcare system improvements | |
Wei 2020 [60] | US | HO | HP | ■ | Barriers: Rapid disease progression; Social distancing measures and visitation restrictions Facilitators: Telehealth/virtual ACP platforms; Tablet computers; ACP/palliative care experts | |
Maia 2020 * [61] | PO | HO | PT | 51 | ■ | Barriers: Personal protective equipment requirements; Social distancing measures and visitation restrictions; Strained healthcare system; Technological/telehealth barriers |
Hendriks 2022 [62] | NL | HO | PT | 275 | ■ | Facilitators: Training for clinicians; Resources for clinicians |
Holdsworth L.M. 2022 [63] | US | HO | HP | 15 | ■ | Barriers: Technological/telehealth barriers; Social distancing measures and visitation restrictions Facilitators: Innovation and flexibility in ACP documentation processes |
Dassel 2021 [64] | US | HC | FC | 82 | ■ | Barriers: Emotional barriers; Social distancing measures and visitation restrictions; Lack of awareness/knowledge of ACP Facilitators: Guidance and protocols for ACP discussions; Resources/education for patients/families |
de Vries 2021 [65] | CN | SV | PB | 3923 | ■ | Barriers: Distrust in the healthcare system Facilitators: Resources/education for patients/families |
Payne 2022 [66] | US | ED | PB | 50 | ■ | Barriers: Lack of awareness/knowledge of ACP Facilitators: Innovation and flexibility in ACP documentation processes; Resources/education for patients/families; Improved messaging |
Ninteau 2022 [67] | US | NH | HP | 7 | ■ | Barriers: Social distancing measures and visitation restrictions Facilitators: ACP/palliative care experts; Training for clinicians; Telehealth/virtual ACP platforms |
Elizondo 2022 * [68] | AR | HO | PT | ■ | Facilitators: Care team collaboration; Innovation and flexibility in ACP documentation processes; Healthcare system improvements | |
Hafid 2022 * [69] | CN | HO | HP | 48 | ■ | Facilitators: Public awareness of ACP; Resources/education for patients/families; Telehealth/virtual ACP platforms |
3.2.2. Education Category
Study ID | Country | Setting | Population | No. of Participants | Quality Assessment | ACP Barriers and Facilitators |
---|---|---|---|---|---|---|
van de Wiel 2022 [70] | BL | AC | MS | 172 | ■ | Facilitators: Training for clinicians |
Casey 2022 [71] | US | HO | PT | 143 | ■ | Facilitators: Training for clinicians; Guidance and protocols for ACP discussions; Innovation and flexibility in ACP documentation processes |
Cousins 2022 [72] | UK | NH | HP, FM | 54 | ■ | Facilitators: Resources/education for patients/families; Resources for clinicians; Training for clinicians |
Rosedale 2022 * [73] | US | HO | PT | ■ | Facilitators: Training for clinicians; ACP/palliative care experts | |
Rabow 2021 [74] | US | OT | HP | ■ | Facilitators: Training for clinicians; Resources for clinicians | |
Oulton 2021 [75] | US | HO | HP | 9 | ■ | Facilitators: Training for clinicians |
Budidi 2021 * [76] | US | AC | HP | 30 | ■ | Barriers: Time constraints; Low education level; Communication difficulties; Technological/telehealth barriers; Lack of adequate ACP training for clinicians Facilitators: Training for clinicians |
Price 2021 * [77] | US | HO | PT | 143 | ■ | Facilitators: Training for clinicians |
Roberts 2020 [78] | US | AC | HP | ■ | Facilitators: Training for clinicians | |
Markwalter 2022 * [79] | US | HO | PT | 143 | ■ | Facilitators: Training for clinicians; Resources for clinicians |
Preston 2022 * [80] | UK | NH | HP, NH, FM | ■ | Barriers: Technological/telehealth barriers Facilitators: Training for clinicians; Resources/education for patients/families | |
Cooney 2022 [81] | US | AC | MS | 83 | ■ | Facilitators: Training for clinicians |
Holdsworth 2022 * [82] | UK | HO | PT | 69 | ■ | Facilitators: Training for clinicians; Identification of those in need of ACP; Guidance and protocols for ACP discussions |
Volandes 2022 [83] | US | HO | PT | 14107 | ■ | Facilitators: Resources/education for patients/families; Training for clinicians |
Mills 2021 [84] | US | HO | HP | 48 | ■ | Facilitators: Telehealth/virtual ACP platforms |
Varey 2021 * [85] | UK | OT | HP, PT, FM | ■ | Facilitators: Resources/education for patients/families | |
Phenwan 2021 [86] | TL | OT | MS, HP, PB | 103 | ■ | Barriers: Cultural and religious beliefs; Lack of awareness/knowledge of ACP Facilitators: Training for clinicians |
Berning 2021 [87] | US | NH | PT | 581 | ■ | Facilitators: Care team collaboration; Identification of those in need of ACP; Guidance and protocols for ACP discussions |
Dobert 2021 * [88] | US | NH | HP | ■ | Facilitators: Care team collaboration; Training for clinicians; Improved messaging; Resources for clinicians; Telehealth/virtual ACP platforms | |
Smith 2020 [89] | US | OT | PT | 413 | ■ | Facilitators: Training for clinicians |
McAfee 2022 [90] | US | AC | PB, HP | ■ | Barriers: Cultural and religious beliefs; Racial and ethnic barriers; Healthcare system barriers; Lack of awareness/knowledge of ACP; Low health literacy; Limited resources: accessibility to health directives | |
Huang 2021 [91] | US | HO | HP | ■ | Barriers: Discomfort among clinicians and patients discussing end-of-life care; Lack of adequate ACP training for clinicians Facilitators: Improved messaging |
3.2.3. Innovation Category
Study ID | Country | Setting | Population | No. of Participants | Quality Assessment | ACP Barriers and Facilitators |
---|---|---|---|---|---|---|
Finger 2022 [92] | US | NH | PT | 24 | ■ | Barriers: Social distancing measures and visitation restrictions; Strained healthcare system Facilitators: Care team collaboration; Guidance and protocols for ACP discussions |
Hannon 2022 * [93] | CN | NH, HO | PT | 26 | ■ | Facilitators: Telehealth/virtual ACP platforms |
Hui 2022 * [94] | US | HO | PT | 12,941 | ■ | Facilitators: Guidance and protocols for ACP discussions; Identification of those in need of ACP; Care team collaboration; Training for clinicians; Healthcare system improvements |
Zhukovsky 2022 * [95] | US | HO | PT | 76 | ■ | Facilitators: Care team collaboration |
Gessling 2022 * [96] | US | OT | PT | 294 | ■ | Facilitators: Telehealth/virtual ACP platforms; Care team collaboration |
Vellani 2022 [97] | CN | HO | PT | 21 dyads | ■ | Barriers: Emotional barriers Facilitators: ACP/palliative care experts; Training for clinicians; Public awareness of ACP; Resources/education for patients/families |
Yen 2022 [98] | TW | HO | PT | 897 | ■ | Barriers: Uncertainty surrounding the COVID-19 prognosis; Limited resources Facilitators: Identification of those in need of ACP |
Liberman 2022 [99] | US | HO | PT | 64 | ■ | Facilitators: Telehealth/virtual ACP platforms; ACP/palliative care experts |
Meyers 2022 * [100] | US | OT | VT | 106 | ■ | Barriers: Social distancing measures and visitation restrictions Facilitators: Identification of those in need of ACP; Telehealth/virtual ACP platforms |
Yourman 2022 * [101] | US | HO | PT | 53 | ■ | Facilitators: Training for clinicians; Telehealth/virtual ACP platforms |
MacInnes 2022 * [102] | UK | OT | HP | ■ | Facilitators: Telehealth/virtual ACP platforms | |
Allen 2021 * [103] | UK | OT | PT, HP, PB | ■ | Facilitators: Resources for clinicians | |
Acevedo Rodriguez 2021 * [104] | US | OT | VT | 500 | ■ | Facilitators: Telehealth/virtual ACP platforms |
Singh 2021 [105] | US | HO | PT | ■ | Facilitators: Care team collaboration; Healthcare system improvements | |
Nandhra 2021 * [106] | UK | NH | PT | 585 | ■ | Facilitators: Identification of those in need of ACP; ACP/palliative care experts |
Paladino 2021 [107] | US | HO | HP | ■ | Facilitators: Guidance and protocols for ACP discussions | |
Lin 2020 [108] | US | ED | HP | ■ | Barriers: Social distancing measures and visitation restrictions Facilitators: Telehealth/virtual ACP platforms; Healthcare system improvements; Tablet computers; Language support services; Training for clinicians | |
Handalage 2020 * [109] | UK | OT | PT | 160 | ■ | Facilitators: Resources for clinicians; ACP/palliative care experts |
Schoenherr 2020 [110] | US | HO | PT | 29 | ■ | Barriers: Social distancing measures and visitation restrictions Facilitators: Identification of those in need of ACP |
Langmaid 2020 [111] | US | OT | PT | ■ | Facilitators: Care team collaboration; Telehealth/virtual ACP platforms | |
Gaur 2020 [112] | US | NH | HP | 10 | ■ | Barriers: Social distancing measures and visitation restrictions Facilitators: Guidance and protocols for ACP discussions |
Bhatia 2021 [113] | US | HO | PT | 356 | ■ | Barriers: Social distancing measures and visitation restrictions Facilitators: Telehealth/virtual ACP platforms; Proactive ACP conversations |
Cavalier 2020 [114] | US | HO | PT | ■ | Facilitators: Innovation and flexibility and in ACP documentation processes | |
Janssen 2020 [115] | NL | SV | HP | 68 | ■ | Facilitators: Proactive ACP conversations |
Baharlou 2020 [116] | US | OT | PT | 183 | ■ | Facilitators: Innovation and flexibility in ACP documentation processes; Understanding/fear of COVID-19; Healthcare system improvements; Care team collaboration; Training for clinicians; ACP/palliative care experts; Telehealth/virtual ACP platforms |
McFarlane 2022 * [117] | UK | ED | PB | 56,343 | ■ | Facilitators: Innovation and flexibility in ACP documentation processes |
Mulyak 2021 * [118] | UK | ED | PT | 107,614 | ■ | Facilitators: Innovation and flexibility in ACP documentation processes |
Hurlow 2021 [119] | UK | ED | PT | ■ | Facilitators: Innovation and flexibility in ACP documentation processes | |
Funk 2020 [120] | US | ED | PB | ■ | Facilitators: Telehealth/virtual ACP platforms; Innovation and flexibility in ACP documentation processes | |
Portz 2020 [121] | US | OT | PB | 3292 | ■ | Facilitators: Innovation and flexibility in ACP documentation processes; Resources/education for patients/families |
Schifeling 2020 [122] | US | OT | PT | 190 | ■ | Facilitators: Telehealth/virtual ACP platforms |
Auriemma 2020 [123] | US | OT | PT, FM | ■ | Facilitators: Resources/education for patients/families |
3.2.4. Recommendation Category
Study ID | Country | Quality Assessment | ACP Barriers and Facilitators |
---|---|---|---|
Auriemma 2022 [124] | US | ■ | Barriers: Social distancing measures and visitation restrictions; Technological/telehealth barriers; Uncertainty surrounding the COVID-19 prognosis; Negative perceptions about advance care planning; Distrust in the healthcare system; Racial and ethnic barriers Facilitators: Identification of those in need of ACP; Guidance and protocols for ACP discussions; ACP/palliative care experts |
Back 2021 [125] | US | ■ | Barriers: Lack of awareness/knowledge of ACP; Uncertainty surrounding the COVID-19 prognosis; Distrust in the healthcare system Facilitators: Improved messaging |
Bender 2021 [126] | US | ■ | Barriers: Time constraints; Limited resources; Healthcare system barriers; Discomfort among clinicians and patients discussing end-of-life care; Strained healthcare system; Personal protective equipment requirements Facilitators: Telehealth/virtual ACP platforms; Care team collaboration; Innovation and flexibility in ACP documentation processes |
Block 2020 [127] | US | ■ | Barriers: Legal concerns; Social distancing measures and visitation restrictions Facilitators: Care team collaboration; Innovation and flexibility in ACP documentation processes; Resources/education for patients/families; Telehealth/virtual ACP platforms |
Chan 2020 [128] | UK | ■ | Barriers: Limited resources; Familial disagreement; Uncertainty surrounding the COVID-19 prognosis; Lack of awareness/knowledge of ACP; Social distancing measures and visitation restrictions Facilitators: Telehealth/virtual ACP platforms; Innovation and flexibility in ACP documentation processes |
Chase 2020 [129] | CN | ■ | Facilitators: Telehealth/virtual ACP platforms; Healthcare system improvements; Guidance and protocols for ACP discussions |
Curtis 2020 [130] | US | ■ | Barriers: Strained healthcare system Facilitators: Telehealth/virtual ACP platforms; Care team collaboration |
Dattolo 2021 [131] | IT | ■ | Barriers: Social distancing measures and visitation restrictions Facilitators: Telehealth/virtual ACP platforms |
Dewhurst 2021 [132] | UK | ■ | Facilitators: Proactive ACP Conversations |
Farrell 2020 [133] | US | ■ | Facilitators: Healthcare system improvements; Care team collaboration: teamwork/multi-disciplinary involvement; Telehealth/virtual ACP platforms; Identification of those in need of ACP |
Gordon 2020 [134] | UK | ■ | Barriers: Social distancing measures and visitation restrictions; Blanket approaches to ACP; Negative perceptions about advance care planning Facilitators: ACP/palliative care experts; Individualized ACP discussion |
Hill 2021 [135] | UK | ■ | Barriers: Social distancing measures and visitation restrictions; Personal protective equipment requirements Facilitators: Telehealth/virtual ACP platforms; Early ACP; Trusting clinical relationship; Innovation and flexibility in ACP documentation processes |
Hopkins 2020 [136] | UK | ■ | Barriers: Social distancing measures and visitation restrictions; Technological/telehealth barriers Facilitators: Triggers to initiate conversations |
Hughes 2021 [137] | US | ■ | Barriers: Distrust in the healthcare system; Lack of awareness/knowledge of ACP Facilitators: Resources for clinicians; Language support services; Improved messaging |
Janwadkar 2020 [138] | US | ■ | Barriers: Limited resources; Time constraints; Rapid disease progression; Social distancing measures and visitation restrictions; Technological/telehealth barriers Facilitators: Telehealth/virtual ACP platforms; Innovation and flexibility in ACP documentation processes |
Kuzuya 2020 [139] | JP | ■ | Barriers: Social distancing measures and visitation restrictions; Rapid disease progression; Communication difficulties Facilitators: Telehealth/virtual ACP platforms; Guidance and protocols for ACP discussions; Information sharing; Care team collaboration |
Moorman 2021 [140] | US | ■ | Barriers: Emotional barriers; Social distancing measures and visitation restrictions; Familial disagreement; Rapid disease progression; Financial concerns; Low education level; Racial and ethnic barriers; Strained healthcare system Facilitators: Trusting clinical relationship |
Palipane 2021 [141] | UK | ■ | Barriers: Rapid disease progression Facilitators: Public awareness of ACP; Guidance and protocols for ACP discussions |
Parekh de Campos 2021 [142] | US | ■ | Barriers: Limited resources; Time constraints; Lack of adequate ACP training for clinicians; Cultural and religious beliefs |
Parks 2021 [143] | US | ■ | Barriers: Social distancing measures and visitation restrictions; Communication difficulties |
Powell 2021 [144] | US | ■ | Barriers: Social distancing measures and visitation restrictions Facilitators: Guidance and protocols for ACP discussions; ACP/palliative care experts |
Sinclair 2020 [145] | AU | ■ | Barriers: Personal protective equipment requirements Facilitators: Resources/education for patients/families; Telehealth/virtual ACP platforms; Resources for clinicians; Innovation and flexibility in ACP documentation processes |
Swinford 2020 [146] | US | ■ | Facilitators: Telehealth/virtual ACP platforms; Care team collaboration; Guidance and protocols for ACP discussions |
Van Buren 2021 [147] | US | ■ | Barriers: Family clustering of COVID-19; Social distancing measures and visitation restrictions Facilitators: Telehealth/virtual ACP platforms; Innovation and flexibility in ACP documentation processes; Care team collaboration; ACP/palliative care experts; Healthcare system improvements; Guidance and protocols for ACP discussions |
Wallace 2020 [148] | US | ■ | Barriers: Rapid disease progression Facilitators: Guidance and protocols for ACP discussions; Resources for clinicians; Innovation and flexibility in ACP documentation processes; ACP/palliative care experts; Telehealth/virtual ACP platforms |
Zaurova 2020 [149] | US | ■ | Barriers: Strained healthcare system; Rapid disease progression; Uncertainty surrounding the COVID-19 prognosis Facilitators: Early ACP; Guidance and protocols for ACP discussions; Triggers to initiate conversations |
3.3. ACP Barriers and Facilitators Coding
3.4. Sub-Analysis of ACP Documentation/Engagement Increase and Decrease
4. Discussion
4.1. Barriers to ACP during the COVID-19 Pandemic
4.2. Facilitators of ACP during the COVID-19 Pandemic
4.3. Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Study Characteristics | n (%) | |
---|---|---|
Type of study | Nonrandomized | 34 (29.6) |
Letters/Opinions/Editorials | 28 (24.3) | |
Quantitative Descriptive | 20 (14.4) | |
Qualitative | 19 (16.5) | |
Reports | 7 (6.1) | |
Mixed methods | 7 (6.1) | |
Country | United States | 70 (60.9) |
United Kingdom | 21 (18.8) | |
Canada | 6 (5.2) | |
The Netherlands | 5 (4.3) | |
Other | 13 (11.3) | |
Setting | Hospital | 42 (36.5) |
Nursing Home | 21 (18.3) | |
Online/Telehealth | 15 (13.0) | |
Electronic data | 9 (7.6) | |
Academic | 5 (4.3) | |
Other | 6 (5.2) | |
Participants | Patients/Nursing home residents | 58 (50.4) |
Healthcare professionals | 34 (29.6) | |
General public | 9 (7.6) | |
Family/Family caregivers | 6 (5.2) | |
Medical students | 3 (2.6) | |
Veterans | 2 (1.7) |
ACP Barrier Codes | Citation | Category | Total | |||
---|---|---|---|---|---|---|
SI | ED | IN | RE | n (%) | ||
Social distancing measures and visitation restrictions | [36,37,39,40,42,44,48,49,53,55,56,60,61,63,64,67,92,100,108,110,112,113,124,127,128,131,134,135,136,138,139,140,143,144,147] | 16 | 0 | 6 | 13 | 35 (20.7) |
Uncertainty surrounding the COVID-19 prognosis | [36,39,40,45,48,49,53,98,124,125,128,149] | 7 | 0 | 1 | 4 | 12 (7.1) |
Technological/Telehealth barriers | [43,49,61,63,76,80,124,136,138] | 4 | 3 | 0 | 3 | 10 (5.9) |
Lack of awareness/knowledge of ACP | [35,55,64,66,86,90,125,128,137] | 4 | 2 | 0 | 3 | 9 (5.3) |
Limited resources | [36,55,90,98,126,128,138,142] | 3 | 1 | 1 | 4 | 9 (5.3) |
Personal protective equipment requirements | [39,40,44,48,53,61,126,135,145] | 6 | 0 | 0 | 3 | 9 (5.3) |
Rapid disease progression | [38,48,60,138,139,140,141,148,149] | 3 | 0 | 0 | 6 | 9 (5.3) |
Strained healthcare system | [40,48,55,61,92,126,130,140,149] | 4 | 0 | 1 | 4 | 9 (5.3) |
Time constraints | [38,44,45,49,55,76,126,138,142] | 5 | 1 | 0 | 3 | 9 (5.3) |
Cultural and religious beliefs | [57,86,90,142] | 2 | 4 | 0 | 1 | 7 (4.1) |
Discomfort among clinicians and patients discussing end-of-life care | [36,38,49,91,126] | 4 | 2 | 0 | 1 | 7 (4.1) |
Healthcare system barriers | [36,49,55,90,126] | 3 | 1 | 0 | 3 | 7 (4.1) |
Emotional barriers | [46,48,82,97,140] | 3 | 0 | 1 | 1 | 5 (3.0) |
Communication difficulties | [57,76,139,143] | 1 | 1 | 0 | 2 | 4 (2.4) |
Distrust in the healthcare system | [65,124,125,137] | 1 | 0 | 0 | 3 | 4 (2.4) |
Legal concerns | [36,55,127] | 2 | 0 | 0 | 2 | 4 (2.4) |
Racial and ethnic barriers | [53,90,124,140] | 1 | 1 | 0 | 2 | 4 (2.4) |
Familial disagreement | [38,128,140] | 1 | 0 | 0 | 2 | 3 (1.8) |
Lack of adequate ACP training for clinicians | [76,91,142] | 0 | 2 | 0 | 1 | 3 (1.8) |
Negative perceptions about advance care planning | [45,124,134] | 1 | 0 | 0 | 2 | 3 (1.8) |
Financial concerns | [57,140] | 1 | 0 | 0 | 1 | 2 (1.2) |
Low education level | [76,140] | 0 | 1 | 0 | 1 | 2 (1.2) |
Blanket approaches to ACP | [134] | 0 | 0 | 0 | 1 | 1 (0.6) |
Family clustering of COVID-19 | [147] | 0 | 0 | 0 | 1 | 1 (0.6) |
Low health literacy | [90] | 0 | 1 | 0 | 0 | 1 (0.6) |
Total | 72 | 20 | 10 | 67 | 169 (100) |
ACP Facilitator Codes | Citations | Category | Total | |||
---|---|---|---|---|---|---|
SI | ED | IN | RE | n (%) | ||
Telehealth/virtual ACP platforms | [36,37,42,45,48,49,51,55,60,67,69,84,88,93,96,99,100,101,102,104,108,111,113,116,120,122,126,127,128,129,130,131,133,135,138,139,145,146,147,148] | 11 | 2 | 14 | 14 | 41 (16.4) |
Training for clinicians | [45,47,62,67,70,71,72,73,74,75,76,77,78,79,80,81,82,83,86,88,89,94,97,101,108,116] | 6 | 18 | 5 | 0 | 29 (11.6) |
Care team collaboration | [45,48,51,59,68,78,87,88,92,94,95,96,105,111,116,126,127,130,133,139,146] | 5 | 3 | 9 | 7 | 24 (9.6) |
Innovation and flexibility in ACP documentation processes | [48,63,66,68,71,116,117,118,119,120,121,126,127,128,135,138,145,147,148] | 5 | 1 | 6 | 10 | 22 (8.8) |
Guidance and protocols for ACP discussions | [45,52,64,71,82,87,92,94,107,112,124,129,139,141,144,146,147,148,149] | 3 | 3 | 4 | 11 | 21 (8.4) |
ACP/palliative care experts | [47,48,51,59,60,67,73,97,99,106,109,116,124,134,144,147,148] | 7 | 1 | 5 | 5 | 18 (7.2) |
Resources/education for patients/families | [36,54,64,65,66,69,72,80,83,85,97,121,123,127,145] | 7 | 4 | 3 | 2 | 16 (6.4) |
Identification of those in need of ACP | [36,40,53,82,87,94,98,100,106,110,124,133] | 3 | 2 | 5 | 2 | 12 (4.8) |
Healthcare system improvements | [49,59,68,94,105,108,116,129,133,147] | 3 | 0 | 5 | 3 | 11 (4.4) |
Improved messaging | [58,66,88,91,125,137] | 2 | 2 | 0 | 7 | 11 (4.4) |
Resources for clinicians | [54,62,72,74,78,88,103,109,137,145,148] | 2 | 4 | 2 | 3 | 11 (4.4) |
Public awareness of ACP | [42,45,48,54,58,69,97,141] | 6 | 0 | 1 | 1 | 8 (3.2) |
Proactive ACP conversations | [36,51,56,113,115,132] | 3 | 0 | 2 | 1 | 6 (2.4) |
Understanding/fear of COVID-19 | [42,46,50,54,116] | 4 | 0 | 2 | 0 | 6 (2.4) |
Trusting clinical relationship | [49,84,135,140] | 1 | 1 | 0 | 2 | 4 (1.6) |
Early ACP | [135,149] | 0 | 0 | 0 | 2 | 2 (0.8) |
Language support services | [108,137] | 0 | 0 | 1 | 1 | 2 (0.8) |
Tablet computers | [60,108] | 1 | 0 | 1 | 0 | 2 (0.8) |
Triggers to initiate conversations | [136,149] | 0 | 0 | 0 | 2 | 2 (0.8) |
Individualized ACP discussion | [134] | 0 | 0 | 0 | 1 | 1 (0.4) |
Information sharing | [139] | 0 | 0 | 0 | 1 | 1 (0.4) |
Total | 69 | 41 | 65 | 77 | 252 (100) |
Study ID | Title | Country | Category | ACP Increase (%) |
---|---|---|---|---|
Auriemma 2020 [123] | Completion of Advance Directives and Documented Care Preferences During the Coronavirus Disease 2019 (COVID-19) Pandemic | US | IN | 396 |
Copley 2021 [54] | ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) in a Pandemic: The impact of COVID-19 on Advance Care Planning in a UK University Hospital Cardiology Department | UK | SI | 355 |
McFarlane 2022 [117] | Advance Care Plans: Creation, Content and Use During Wave 1 of the COVID-19 Pandemic. A Retrospective Cohort Study of Coordinate My Care, a Large Electronic Palliative Care Coordination System | UK | IN | 296 |
Connellan 2021 [50] | Documentation of Do-Not-Attempt-Cardiopulmonary-Resuscitation orders amid the COVID-19 pandemic | IR | SI | 291.5 |
Hurlow 2021 [119] | An evaluation of advance care planning during the COVID-19 pandemic: a retrospective review of patient involvement in decision making using routinely collected data from digital ReSPECT records | UK | IN | 230.9 |
Portz 2020 [121] | Advance Care Planning Among Users of a Patient Portal During the COVID-19 Pandemic: Retrospective Observational Study | US | IN | 148 |
Yourman 2022 [101] | Acceptability and Effectiveness of Virtual Group Visits for Advance Care Planning | US | IN | Virtual ACP: 35 Clinic ACP: 136 |
Gaur 2020 [112] | A Structured Tool for Communication and Care Planning in the Era of the COVID-19 Pandemic | US | IN | 114 |
Casey 2022 [71] | Advance Care Planning for Emergency Department Patients With COVID-19 Infection: An Assessment of a Physician Training Program | US | ED | 101.6 |
Price 2021 [77] | An Educational Intervention to Increase Advance Care Planning Activities among Emergency Medicine Providers during the COVID-19 Pandemic | US | ED | 98.4 |
Meyers 2022 [100] | Advance Care Planning in a Geriatric Veterans Primary Care Clinic During COVID-19 | US | IN | 78 |
Berning 2021 [87] | An advance care planning long-term care initiative in response to COVID-19 | US | ED | 46 |
Acevedo Rodriguez 2021 [104] | Improving the quality of care in patients with COVID-19 | US | IN | AD: 37 LST notes: 3163 |
Hui 2022 [94] | Impact of an interdisciplinary goals of care program on hospital outcomes at a comprehensive cancer center during the COVID-19 pandemic: A propensity score analysis. | US | IN | 33.3 |
Volandes 2022 [83] | Association of an Advance Care Planning Video and Communication Intervention With Documentation of Advance Care Planning Among Older Adults: A Nonrandomized Controlled Trial | US | ED | 32 |
Rosedale 2022 [73] | Advance Care Planning and Health Equity: Pursuing Quality Improvement in a Family Medicine Residency Clinic | US | ED | 27.9 |
Markwalter 2022 [79] | Advance Care Planning for Emergency Department Patients with COVID-19 Infection: An Assessment of a Physician Training Program | US | ED | 25.4 |
Singh 2021 [105] | Increasing Medical Power of Attorney Completion for Hospitalized Patients During the COVID Pandemic: A Social Work Led Quality Improvement Intervention | US | IN | 12.7 |
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Mayers, T.; Sakamoto, A.; Inokuchi, R.; Hanari, K.; Ring, H.Z.; Tamiya, N. Situation, Education, Innovation, and Recommendation: A Large-Scale Systematic Review of Advance Care Planning in the Age of COVID-19. Healthcare 2024, 12, 667. https://doi.org/10.3390/healthcare12060667
Mayers T, Sakamoto A, Inokuchi R, Hanari K, Ring HZ, Tamiya N. Situation, Education, Innovation, and Recommendation: A Large-Scale Systematic Review of Advance Care Planning in the Age of COVID-19. Healthcare. 2024; 12(6):667. https://doi.org/10.3390/healthcare12060667
Chicago/Turabian StyleMayers, Thomas, Ayaka Sakamoto, Ryota Inokuchi, Kyoko Hanari, Huijun Z. Ring, and Nanako Tamiya. 2024. "Situation, Education, Innovation, and Recommendation: A Large-Scale Systematic Review of Advance Care Planning in the Age of COVID-19" Healthcare 12, no. 6: 667. https://doi.org/10.3390/healthcare12060667