Effects of Advance Care Planning on Knowledge, Behavior and Well Being of Older People: A Systematic Review Protocol

Saturday, 26 July 2014

Mi Fun Ng, RN, BN, MN
Doris Y. P. Leung, BSc, MPhil, PhD
Helen Y. L. Chan, RN, PhD
The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, Hong Kong


Advance Care Planning is a process of discussion about an individual’s preferences for care in their anticipation of future deterioration. There are different formats and inconsistent approach in implementing Advance Care Planning to older people. The effectiveness of Advance Care Planning intervention will influence on the knowledge, behavior and well- being in older people.

Method of review:

Inclusion Criteria

Types of participants:

  • Older people who are age 60 or over                                                     
  • With or without chronic illness, no restriction on any disease groups and health status of participants

Types of interventions:

 Advance Care Planning (ACP) refers to a process of discussing on end of life care/ determining/ executing treatment directives/ appointing a proxy decision maker, or a combination of both  

Formats: Self- administered computerized program, self- administered form, video, individual or group interview, information  sharing sessions, decision making meeting, counseling, single or multiple sessions

Types of studies:

Studies designed in randomized control trial (RCT) to evaluate the outcomes of ACP

In absence of RCT, quasi-experimental studies will be included

Types of comparison:

  • Comparison between usual care or practice (no ACP program) with the ACP intervention
  • Comparison between two or more types of ACP-related interventions
  • Comparison between different combinations of format of ACP-related interventions

Types of outcomes:

1. Knowledge:

refer to the knowledge, understanding & awareness related to ACP & end of life care

Outcome measures

 client’s knowledge in:


•advance directives

•appoint proxy

•knowledge of current & future health state

•associated management

2. Behavior:

Refers to client’s action taken after ACP

Outcome measures:

•identify preference of care or proxy

•documentation on their preferences for CPR, artificial nutrition, intravenous antibiotic etc.

•appointment of proxy

•health services utilization e.g. hospitalization, length of stay, clinic attendance, A & E attendance

3. Well- being:

Focus on client’s psychological state after the intervention

Outcome measures:

•client’s satisfaction

•level of stress/ anxiety

•quality of life

•communication or relationship with others (relatives & health care providers)

Studies published in English and Chinese will be searched by three steps approach.

Selected eligible articles will be managed by RevMan. The result will be pooled in statistical meta- analysis. Subgroup analysis will be conduct when there are heterogeneity in terms of study design, participants etc. For findings which are statistically analysis inappropriate, narrative summary will be provided