Efficacy of Nurse-Led Advance Care Planning in Patients with Chronic Diseases: A Systematic Review

Advance care planning (ACP) allows patients to discuss and negotiate their preferences for the future including clinical management at the end of life. Over the past few decades, despite multiple large-scale educational and legal efforts to promote engagement in advance care planning and completion of advance directives, over 60 percent of Americans have not completed advance directives (AD). Vulnerable populations such as elderly individuals and patients with chronic diseases are in particular need of ACP. Even though AD completion rates have increased, there is more work to be done. Barriers to advance care planning cited by studies include unwillingness by patients to engage in ACP and overestimation of prognosis (Hole and Salem, 2016). Physician-related barriers include limited time and poor ACP documentation (Bergenholtz et al. 2019). To address the gaps in ACP, research has examined the impact of non-physician members of the health care team on ACP engagement. The purpose of this systematic review was to evaluate the effectiveness of nurse-led advance care planning and engagement in EOL discussions on advance directive participation rates among adult patients with chronic diseases. Four final studies were included in this systematic review utilizing PRISMA guidelines and CASP tool for to ensure study integrity. Results of this review demonstrate the benefits of nurse involvement in ACP. The ACP process is multifactorial with many aspects in which nurses can have impact. Implications of this study include the importance for APRNs to identify where nurses can be involved in the ACP process to improve AD completion rates and documentation. APRNs can be at the forefront in improving education and training in ACP and can become more involve in policies that support improved ACP.