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Chronic heart failure (CHF) is a progressive life-limiting condition that necessitates early implementation of advance care planning (ACP). However, patients and caregivers encounter emotional, informational, and cultural barriers to effective ACP engagement. This meta-synthesis consolidates qualitative evidence to deepen our understanding of ACP practices in CHF care.
This study aimed to explore experiences of CHF patients and their caregivers in ACP, which is defined as a proactive decision-making process to establish future treatment plans based on patients' values. The study also aimed to identify barriers and facilitators influencing ACP decisions and assess the impact of flexible, personalized ACP approaches on care quality.
Using qualitative meta-synthesis, we analyzed 10 qualitative studies on CHF patients' and caregivers' ACP experiences. Data were thematically synthesized to identify emotional, relational, and practical factors that influence engagement in ACP.
Three themes emerged: (1) heart failure patients and caregivers face difficulties in ACP (difficulties from patients, difficulties from the family, and difficulties from the society), (2) multidimensional drivers and impacts of ACP (advance care planning drivers, acceptance and implementation of ACP, emotions and effects of ACP), (3) flexible, personalized ACP delivers tangible benefits (timing and effectiveness of ACP discussions, patients and caregivers have personalized needs for ACP, and patients and caregivers affirm ACP benefits).
ACP plays a critical role in improving end-of-life care quality and reducing emotional and decision-making burdens on caregivers. Flexible and personalized ACP strategies supported by trained healthcare professionals more effectively meet the unique needs of patients and families. To overcome persistent barriers and promote broader ACP adoption, healthcare systems should prioritize provider communication training, ACP education, and support systems tailored to diverse cultural contexts.
Cognitive decline, including subjective cognitive decline (SCD), mild cognitive impairment (MCI), and dementia, significantly affects social participation, leading to social isolation and reduced quality of life. Enhancing social participation through interventions may mitigate these effects, yet evidence on intervention effectiveness and mechanisms remains inconsistent.
To evaluate the effectiveness of social participation interventions for individuals with cognitive decline and identify effective behavior change techniques (BCTs) supporting social participation.
Our search using the following databases—PubMed, Web of Science, Embase, Cochrane Library, CINAHL, Scopus, CNKI, and Wanfang—was conducted until October 2024. The quality of the included studies was assessed using the Cochrane risk of bias tool for randomized trials. Meta-analyses were conducted using Review Manager 5.4 and Stata18, and the certainty of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation approach.
Sixteen RCTs involving 2190 participants were included. Music therapy (SMD = 0.62, 95% CI [0.15, 1.10]) and reminiscence therapy (SMD = 0.34, 95% CI [0.02, 0.66]) demonstrated significant positive effects on social participation. Group-based interventions were particularly effective (SMD = 0.23, 95% CI [0.04, 0.43]). Commonly used BCTs included goal setting, behavioral practice/rehearsal, and social support. However, substantial heterogeneity and limited data on SCD and MCI restricted generalizability.
Interventions promoting social participation may enhance engagement for individuals with cognitive decline, particularly through music therapy, reminiscence therapy, and group-based formats. The complexity and dynamic nature of social interaction require individuals to engage and integrate various cognitive functions and skills, which can present significant challenges for older adults with cognitive impairments in their daily social participation. Further research is needed to optimize intervention components and address gaps in targeting early cognitive decline stages.
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