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A systematic review of evidence for end-of-life communication interventions: Who do they target, how are they structured and do they work?

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Title: A systematic review of evidence for end-of-life communication interventions: Who do they target, how are they structured and do they work?
Authors: Walczak, Adam1 adam.walczak@sydney.edu.au, Butow, Phyllis N.1, Bu, Stella1, Clayton, Josephine M.1,2
Source: Patient Education & Counseling. Jan2016, Vol. 99 Issue 1, p3-16. 14p.
Subject Terms: *Medical education, *Caregivers, *Communication, Terminal care, Medical care, Medical databases, Medical practice, Systematic reviews, Medical personnel, Advance directives (Medical care)
Abstract: Objective: To identify and synthesise evidence for interventions targeting end-of-life communication.Methods: Database, reference list and author searches were conducted to identify evaluations of end-of-life communication-focussed interventions. Data were extracted, synthesised and QUALSYST quality analyses were performed.Results: Forty-five studies met inclusion criteria. Interventions targeted patients (n=6), caregivers (n=3), healthcare professionals (HCPs n=24) and multiple stakeholders (n=12). Interventions took various forms including communication skills training, education, advance care planning and structured practice changes. Substantial heterogeneity in study designs, outcomes, settings and measures was apparent and study quality was variable.Conclusion: A substantial number of end-of-life communication interventions have been evaluated. Interventions have particularly targeted HCPs in cancer settings, though patient, caregiver and multi-focal interventions have also been evaluated. While some interventions were efficacious in well-designed RCTs, most evidence was from less robust studies. While additional interventions targeting patients and caregivers are needed, multi-focal interventions may more effectively remove barriers to end-of-life communication.Practice Implications: Despite the limitations evident in the existing literature, healthcare professionals may still derive useful insights into effective approaches to end-of-life communication if appropriate caution is exercised. However, additional RCTs, implementation studies and cost-benefit analyses are required to bolster arguments for implementing and resourcing communication interventions. [ABSTRACT FROM AUTHOR]
Copyright of Patient Education & Counseling is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Education Research Complete
FullText Text:
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DbLabel: Education Research Complete
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PubType: Academic Journal
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  Data: A systematic review of evidence for end-of-life communication interventions: Who do they target, how are they structured and do they work?
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  Data: *<searchLink fieldCode="DE" term="%22Medical+education%22">Medical education</searchLink><br />*<searchLink fieldCode="DE" term="%22Caregivers%22">Caregivers</searchLink><br />*<searchLink fieldCode="DE" term="%22Communication%22">Communication</searchLink><br /><searchLink fieldCode="DE" term="%22Terminal+care%22">Terminal care</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+care%22">Medical care</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+databases%22">Medical databases</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+practice%22">Medical practice</searchLink><br /><searchLink fieldCode="DE" term="%22Systematic+reviews%22">Systematic reviews</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+personnel%22">Medical personnel</searchLink><br /><searchLink fieldCode="DE" term="%22Advance+directives+%28Medical+care%29%22">Advance directives (Medical care)</searchLink>
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  Data: <bold>Objective: </bold>To identify and synthesise evidence for interventions targeting end-of-life communication.<bold>Methods: </bold>Database, reference list and author searches were conducted to identify evaluations of end-of-life communication-focussed interventions. Data were extracted, synthesised and QUALSYST quality analyses were performed.<bold>Results: </bold>Forty-five studies met inclusion criteria. Interventions targeted patients (n=6), caregivers (n=3), healthcare professionals (HCPs n=24) and multiple stakeholders (n=12). Interventions took various forms including communication skills training, education, advance care planning and structured practice changes. Substantial heterogeneity in study designs, outcomes, settings and measures was apparent and study quality was variable.<bold>Conclusion: </bold>A substantial number of end-of-life communication interventions have been evaluated. Interventions have particularly targeted HCPs in cancer settings, though patient, caregiver and multi-focal interventions have also been evaluated. While some interventions were efficacious in well-designed RCTs, most evidence was from less robust studies. While additional interventions targeting patients and caregivers are needed, multi-focal interventions may more effectively remove barriers to end-of-life communication.<bold>Practice Implications: </bold>Despite the limitations evident in the existing literature, healthcare professionals may still derive useful insights into effective approaches to end-of-life communication if appropriate caution is exercised. However, additional RCTs, implementation studies and cost-benefit analyses are required to bolster arguments for implementing and resourcing communication interventions. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Patient Education & Counseling is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=ehh&AN=112127720
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        Value: 10.1016/j.pec.2015.08.017
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