A Scoping Review of Advance Care Planning Support for Patients in Intensive Care Units

Kanako Yamamoto; Junko Hayama; Yuki Yonekura; Kazuhiro Nakayama; Erika Ota

Authors

Kanako Yamamoto MSN, RN, CNS, Graduate School of Nursing Science, Nursing Informatics, St. Luke’s International University, Tokyo, Japan.
Junko Hayama MSN, RN, Graduate School of Nursing Science, Nursing Infomatics, St. Luke’s International University, Tokyo, Japan
Yuki Yonekura PhD, Associate Professor, Graduate School of Nursing Science, Nursing Informatics, St. Luke’s International University, Tokyo, Japan
Kazuhiro Nakayama PhD, Professor, Graduate school of nursing science, Nursing Informatics, St. Luke’s International University, Tokyo, Japan
Erika Ota PhD, RN, PHN, Professor, Graduate School of Nursing Science, Global Health Nursing, St. Luke’s International University, Tokyo, Japan and Tokyo Foundation for Policy Research, Tokyo, Japan

Keywords:

Advance care planning, Advance directives, Critical care, End-of-life, Intensive care unit, Palliative care, Perioperative period

Abstract

Deciding whether to stop life-saving treatment for patients receiving intensive care, and who have poor recovery prospects, is challenging. Due to patients’ inability to make these decisions and the difficulties in fulfilling their wishes regarding treatment, family members often need to decide themselves. Advance care planning support has been expanding to improve the quality of end-of-life care, but its effectiveness in intensive care units is unclear. This scoping review aimed to elucidate the effectiveness of advance care planning interventions for patients entering intensive care units, and their families.
The PRISMA-ScR checklist was used to report this review. We searched the databases of BNI, CINAHL, EMBASE, Ichushi-Web, PsycINFO, PubMed, The Cochrane Library, OpenGrey, and the Trip medical database for published and unpublished studies in intensive care units from January 2000 to March 2020. Studies on adult patients admitted to intensive care units were included, while studies on patients being treated for mental health conditions, terminally ill patients, new mothers, and patients in nursing homes and hospices were excluded.
Three quantitative studies and one qualitative study were included in this review. Literature analysis revealed that an advance care planning intervention involving patients in intensive care units in the perioperative period and their families significantly improved their knowledge; documenting the patient’s intentions helped reduce decision-making conflicts and enhanced care satisfaction. Barriers to preparing advance care planning included a lack of information and support by healthcare providers. The reviewed studies indicated that medical professionals and families could make surrogate decisions based on patients’ wishes and values by supporting advance care planning.

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