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Advance care planning (ACP) enables individuals with life-limiting illnesses to make decisions regarding future healthcare. It involves patients, families and healthcare providers in discussions on treatment preferences and end-of-life care. Understanding their experiences is key to improving ACP practice.
To systematically review and analyse the experiences of patients, families and healthcare providers with ACP for life-limiting illnesses.
This study employed a mixed-methods systematic review (MMSR) with a convergent integrated approach.
Literature searches were conducted using CINAHL, Cochrane Library, ERIC, MEDLINE, Scopus and Web of Science, as well as hand searches and reference list checking, for articles published between 2010 and August 2024. Two independent reviewers extracted and analysed the data using the JBI guidelines for MMSR.
Of the 1405 citations, 26 studies involving 1599 participants (1076 patients, 398 healthcare providers and 125 family members) were included. The main findings highlight the importance of patient empowerment, family involvement and the integration of ACP into routine care. Eliminating barriers, such as lack of training, resource limitations and challenges with timing discussions, are essential for effective ACP implementation.
The MMSR emphasises the need for patient-centred ACP that actively involves families and addresses systemic barriers. Early initiation, tailored emotional support and equitable care across conditions are crucial for an effective ACP.
The MMSR highlights the importance of family involvement and enhanced training for healthcare providers in ACP, emphasising the need for emotional support and systemic changes to improve patient care. These improvements should include better educational programs and policies to ensure early, effective and equitable ACP discussions among various patient groups.
The MMSR underscores the need for structured ACP practices that are currently limited by insufficient training and vague guidelines. Early initiation of ACP discussions and inclusion of patient and family preferences are essential for improving care for individuals with life-limiting conditions. These findings are vital for healthcare providers, policymakers and educators to implement more effective patient-centred ACP approaches. Family involvement remains a key aspect, with the review advocating for a support system that empowers families to play an active role in ACP.
Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA).
No Patient or Public Contribution.
This study aimed to investigate the factors influencing nurses' intentions to participate in advance care planning (ACP) by examining the mediating roles of attitude, subjective norm, and perceived behavioural control in the relationship between knowledge and intention, using an extended theory of planned behaviour and structural equation modelling.
A descriptive cross-sectional survey was conducted between January and April 2023, involving 515 registered nurses, selected through two-stage sampling. Data were collected using a self-administered online survey distributed via the internal communication system of hospital. Structural equation Modelling was employed to analyse the relationships among knowledge, attitude, subjective norm, perceived behavioural control and intention to participate in ACP.
The results supported two hypotheses regarding the relationships between knowledge, attitude, subjective norm, perceived behavioural control, and intention (p < 0.05). While the direct effect of knowledge on intention was not significant (β = 0.087, p = 0.292), the total indirect effect through attitude, subjective norm and perceived behavioural control was significant (β = 0.449, p < 0.001), accounting for approximately 83.77% of the total effect on intention. This underscores the critical role of these mediators in influencing nurses' intention to participate in ACP.
This study highlights the significant indirect influence of knowledge on nurses' intentions to participate in ACP through attitude, subjective norms and perceived behavioural control. These findings suggest that targeted educational is needed to enhance ACP participation among nurses.
Understanding the role of attitude, subjective norm and perceived behavioural control can enhance nursing practice. Creating supportive environments and promoting interdisciplinary collaboration are crucial. Professional development through training, mentorship and role modelling can empower nurses in ACP. Comprehensive programs that increase knowledge and foster positive attitudes are essential for advancing ACP practice among nurses.
Educational programs aimed at nurses should include components designed to strengthen knowledge and the identified mediators, equipping nurses with the necessary ACP skills. Organizational support through appropriate policy frameworks can facilitate these educational endeavours and ensure a sustainable impact on practice.
The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies.
To analyse healthcare providers' (HCPs) experiences in sexual health care through the mixed-methods systematic review (MMSR).
Sexual health for breast cancer survivors (BCSs) is becoming increasingly important as survivors live longer. HCPs are critical in providing sexual health care.
A mixed-methods systematic review.
Literature searches were conducted in databases MEDLINE, CINAHL, Psychology & Behavioral Sciences Collection, Web of Science, Cochrane Library, Scopus, ClinicalTrials.gov and reference lists were searched from inception to 30 December 2022. Two independent reviewers extracted and analysed the data using the JBI guidelines for MMSR.
After screening for 2849 citations, 19 studies were eligible for MMSR, involving 2068 HCPs. Most HCPs believe that sexual health care is their responsibility. However, sexual health was not adequately addressed. A lack of knowledge was the most significant barrier to providing sexual health care. Moreover, HCPs would like to acquire more knowledge and felt that current sexual healthcare training was inadequate.
Findings suggest that HCPs did not frequently address sexual health in BCSs and that lack of knowledge was the most common barrier. Healthcare session administrators should allocate resources for sexual healthcare training that offer multiple formats, accessible content and convenience. They should also be multifaceted and proactive, meet the diverse needs of BCS at different stages and focus on effective communication.
This study highlights the importance of addressing sexual health in BCSs and the need for HCPs to receive training in this area. Training should be multifaceted, proactive and meet the diverse needs of BCSs at different stages, with a focus on effective communication. By addressing this issue, HCPs will be better equipped to support the sexual health needs of BCSs, ultimately improving their overall well-being and quality of life.
PROSPERO Registration Number: CRD42022327018 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=327018).
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