Respecting Choices and Related Models of Advance Care Planning: A Systematic Review of Published Evidence.
Meredith A MacKenzie, Esther Smith-Howell, Patricia A Bomba and 1 others
PMID 29254357WHAT IT FOUND
Respecting Choices models consistently improve agreement between patients and surrogates on hypothetical end-of-life preferences and increase the completion of advance directives.
However, evidence is mixed and low-quality for whether these plans actually align with real-world treatment or reduce healthcare utilization.
Key findings
01There is high-level evidence that Respecting Choices models positively impact patient-surrogate congruence in hypothetical scenarios among Caucasian populations, but mixed, low-level evidence for consistency between actual treatment and expressed wishes.
02Low-level evidence supports that these models increase the completion of Advance Directives and POLST orders when compared to inactive controls in Caucasian populations.
03The models were never tested against other methods of advance care planning, and the high cost of implementation makes it difficult to determine if less expensive interventions achieve comparable outcomes.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
High risk of selection bias in 87.5% of included studies. Performance bias was common because control groups typically received no intervention or passive education, while intervention groups received active, in-person counseling. Most studies focused on Caucasian populations, limiting generalizability to other racial and ethnic groups. The studies did not compare Respecting Choices to other active advance care planning models, so its relative effectiveness is unknown. Many studies were small pilots or observational designs with inadequate reporting of attrition and blinding.
Declared interests
Not reported in the provided text.
The easy way to misread this
Do not conclude that this model improves the quality of end-of-life care. While it increases paperwork and hypothetical agreement, the review found mixed and low-quality evidence that it leads to treatment that actually matches patient wishes or reduces healthcare utilization.