Effective communication and informed decision-making are paramount for patients facing serious illnesses and their families, significantly impacting the quality of end-of-life care. While numerous communication tools designed to aid patients, families, and healthcare professionals in navigating end-of-life decisions exist, their actual effectiveness has remained a subject of investigation. This article delves into the impact of structured communication tools on advance care planning completion among adults in ambulatory care settings.
The Impact of Communication Tools on End-of-Life Care
Research was conducted to evaluate the effectiveness of structured communication tools in end-of-life care. This comprehensive study involved a thorough search of major databases, including MEDLINE, EMBASE, CINAHL, ERIC, and the Cochrane Database of Randomized Controlled Trials, spanning from database inception up to July 2014. The research focused on randomized controlled trials (RCTs) and non-randomized intervention studies to provide a robust analysis. Independent reviews and data extraction were performed to ensure the integrity of the findings, and the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach was utilized to rigorously assess the quality of evidence for primary and secondary outcomes.
The study encompassed a significant 67 studies, with 46 being RCTs. A large portion of these studies focused on older patients, typically over the age of 50, without specifying particular medical conditions. However, substantial attention was also given to patient populations facing specific health challenges such as cancer, lung disease, heart conditions, neurological disorders, or renal disease. The majority of these studies benchmarked the use of communication tools against standard or usual care practices. Furthermore, some research compared these tools against less intensive methods of advance care planning, providing a spectrum of comparative analysis.
The findings revealed compelling evidence supporting the use of structured communication tools in end-of-life care. These tools demonstrably increased the occurrence of both advance care planning discussions and conversations specifically about advance directives. Statistical analysis indicated a Relative Risk (RR) of 2.31 (95% CI 1.25-4.26, p = 0.007), although the quality of evidence was categorized as low. Moreover, the completion rate of advance directives (ADs) also saw a significant rise with the use of these tools, showing an RR of 1.92 (95% CI 1.43-2.59, p<0.001), again with low quality evidence. In terms of aligning patient preferences with medical interventions, the research pointed to improved concordance between preferences stated in ADs and the subsequent medical orders regarding life-sustaining treatment. This alignment was noted with an RR of 1.19 (95% CI 1.01-1.39, p = 0.028), though the evidence quality was very low and derived from a single observational study. Finally, and crucially, the concordance between the care patients desired and the actual care they received also improved (RR 1.17, 95% CI 1.05-1.30, p = 0.004, low quality evidence, based on 2 RCTs).
Conclusion
In conclusion, the evidence suggests that incorporating structured communication tools in end-of-life care has a positive impact. These tools are likely to enhance the frequency of discussions surrounding advance directives and increase the completion of these crucial documents. Furthermore, they contribute to better alignment between the care patients wish to receive and the care that is actually provided. Therefore, healthcare settings should seriously consider utilizing structured communication tools over less systematic approaches to end-of-life decision-making. The selection and implementation of these tools should be thoughtfully customized to meet the specific needs and context of each local environment, ensuring the most effective and patient-centered application.
