Effectiveness of dyadic advance care planning: a systematic review and meta-analysis

Context Making decisions regarding end-of-life care is particularly challenging for patients and their family caregivers. Studies have advocated that family involvement in advance care planning is important to provide goal-concordant care and to increase family caregivers’ preparation for surrogate decision-making. However, there is a lack of evidence to examine the effectiveness of advance care planning using the patient-caregiver dyadic approach. Objectives To evaluate the effectiveness of dyadic advance care planning. Methods A literature search was systematically carried out in 7 databases from inception to March 2023. All randomized controlled trials with advance care planning interventions for mentally competent adults and their family caregivers were included. Meta-analysis was conducted for available quantitative data related to end-of-life care; Otherwise, narrative syntheses were performed. Results In total, 14 randomized controlled trials were included. The main contents of all interventions were summarized into five categories, namely sharing illness experience and perception, introducing knowledge about advance care planning and end-of-life care, discussing individual's/ dyads’ values, goals, and care preferences, addressing dyads’ discordance, and providing supports to complete advance care planning behaviors. The meta-analysis showed that dyadic advance care planning had significant effects on advance directive documentation (OR=7.58, 95% CI [1.41, 40.63], p=0.02) and proactive communication with doctors (OR=2.42, 95% CI [1.42, 4.12], p=0.001). In addition, interventions may improve dyad's congruence on end-of-life care, family caregivers’ confidence in surrogate decision-making, and quality of end-of-life communication. Conclusions This review supports that dyadic advance care planning is a promising approach to preparing patients and their family caregivers for end-of-life communication and decision-making. Given that this multifaceted process is influenced by multiple factors within the socio-cultural context, future studies are warranted to identify the barriers and facilitators to implement dyadic advance care planning in real-world settings.