Authors' recommendations: Based on the best available evidence, it is clear that single-provider and team-based patient care planning discussions (PCPDs) provide benefits for patients at the end of life (EoL) and their families. These benefits can be observed in terms of patient-centred outcomes and the use of health care resources. Additionally, earlier PCPDs are associated with better patient-centred and utilization outcomes. High-quality evidence with large magnitudes of effect lend moderate certainty to the conclusion that single-provider PCPDs: - Improve families' satisfaction with EoL care and concordance between patients' and families' wishes. - Reduce the likelihood of receiving hospital care and the number of days spent in hospital. - Increase the completion of advance care planning (ACP) processes and documents and the likelihood of receiving hospice care. Moderate- to high-quality evidence with large magnitudes of effect indicate, with moderate certainty, that team-based PCPDs: - Increase patient satisfaction and the completion of ACP documents and processes. - Reduce the number of days spent in intensive care and decrease the use of outpatient services. Finally, moderate-quality evidence indicates that earlier PCPDs are associated with reduced hospital care and with increased hospice care. The body of evidence used in this evidence-based analysis suffered from common limitations, described below. - Some of the randomized controlled trials were unblinded, and in some cases blinding was done inappropriately or not reported. This could have led to an overestimation of the effect estimates. - Most studies did not specify how missing data were handled. Because the patients included in the studies were at the EoL, and patients who died likely had a different EoL trajectory or prognosis than those who completed the studies, missing data could have introduced attrition bias. The direction in which this bias would have affected the results is unclear. - In some observational studies, exposure to the intervention was measured on the basis of a patient's or family member's response to a single question about discussing EoL care plans with a health care provider. Furthermore, the interventions were often not described in enough detail. As a result, it was impossible to compare multiple components of each intervention or assess how well the intervention was delivered. - Usual care was not defined in most studies, so it is possible that some effect estimates, especially those related to team-based PCPDs, were underestimated. - Studies that measured satisfaction with care and quality of life used a variety of instruments that did not consistently assess the same components of the construct being measured, so their results, as part of an overall body of evidence for those outcomes, should be interpreted cautiously.

Project Status: Completed

Year Published: 2014

URL for published report: http://www.hqontario.ca/Portals/0/Documents/eds/ohtas/eba-eol-planning-discussions-1411-en.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Health Quality Ontario

Contact Address: Evidence Development and Standards, Health Quality Ontario, 130 Bloor Street West, 10th floor, Toronto, Ontario Canada M5S 1N5

Contact Name: EDSinfo@hqontario.ca

Contact Email: OH-HQO_hta-reg@ontariohealth.ca

Copyright: Health Quality Ontario