Advance Care Planning Interventions for Adults With Chronic Kidney Disease: A Systematic Review.
Juthamas Tiansaard, Melissa J Bloomer, Louise Purtell and 1 others
PMID 41582599WHAT IT FOUND
Some nurse-led ACP conversations with education or peer support increased completed advance directives and surrogate decision-maker identification in adults with CKD.
Effects varied across studies, and no single best method was shown.
Key findings
01Twelve studies evaluated ACP documentation completion, and five reported statistically significant increases after interventions.
02A nurse-led programme reported a higher ACP document completion rate, and adults who had ACP conversations with a trained nurse were more likely to identify a caregiver surrogate than those receiving usual kidney care (67.2% vs 5.2%).
03Participants reported that ACP conversations did not increase anxiety, made them feel hopeful, and family involvement gave relief.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The included studies were heterogeneous in intervention type, delivery mode, outcome measures, frequency and follow-up. Intervention frequency ranged from one to eight sessions, and follow-up periods ranged from 1 day to 12 months. The review did not assess certainty of evidence because study designs and outcomes varied too much for meta-analysis. Only five of twelve studies that evaluated ACP documentation completion reported statistically significant increases, and studies using educational resources alone did not show significant increases. The review included only English-language studies and was mostly conducted in Western countries, so cultural and legal differences may change results. Some included studies had mixed participants with other chronic diseases, and outcomes were sometimes reported together with non-CKD participants. The authors concluded there is insufficient evidence to reliably inform practice.
Declared interests
The authors received no specific funding and declared no conflicts of interest.
The easy way to misread this
Do not read this as proof that ACP interventions reliably improve kidney care. Only five of twelve studies that evaluated documentation completion reported statistically significant increases, educational resources alone did not show significant increases, and the authors said there is insufficient evidence to reliably inform practice.