Don't Throw the Baby Out With the Bathwater: Meta-Analysis of Advance Care Planning and End-of-life Cancer Care

Context. There is ongoing discourse about the impact of advance care planning (ACP) on end-of-life (EOL) care. No meta-analysis exists to clarify ACP's impact on patients with cancer.Objective. To investigate the association between, and moderators of, ACP and aggressive vs. comfort-focused EOL care out-comes among patients with cancer.Methods. Five databases were searched for peer-reviewed observational/experimental ACP-specific studies that were pub-lished between 1990-2022 that focused on samples of patients with cancer. Odds ratios were pooled to estimate overall effects using inverse variance weighting.Results. Of 8,673 articles, 21 met criteria, representing 33,541 participants and 68 effect sizes (54 aggressive, 14 comfort-focused). ACP was associated with significantly lower odds of chemotherapy, intensive care, hospital admissions, hospice use fewer than seven days, hospital death, and aggressive care composite measures. ACP was associated with 1.51 times greater odds of do-not-resuscitate orders. Other outcomes-cardiopulmonary resuscitation, emergency department admissions, mechanical ventilation, and hospice use-were not impacted. Tests of moderation revealed that the communication components of ACP produced greater reductions in the odds of hospital admissions compared to other components of ACP (e.g., documents); and, observational studies, not experimental, produced greater odds of hospice use.Conclusion. This meta-analysis demonstrated mixed evidence of the association between ACP and EOL cancer care, where tests of moderation suggested that the communication components of ACP carry more weight in influencing outcomes. Further disease-specific efforts to clarify models and components of ACP that work and matter to patients and caregivers will advance the field. J Pain Symptom Manage 2023;65:e715-e743. (c) 2023 American Academy of Hospice and Palliative Medicine. Published by Elsev-ier Inc. All rights reserved.

Automated summary

This meta-analysis investigates the association between advance care planning (ACP) and end-of-life (EOL) care outcomes in cancer patients. The results show that ACP is associated with a reduced likelihood of aggressive EOL care, such as chemotherapy, intensive care, hospital admissions, and hospital death, while increasing the odds of do-not-resuscitate orders.