Life In The Slower Lane

Here is the standardised PICO analysis for the fourth uploaded article:

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Full Title

Effectiveness of advance care planning programmes in improving end-of-life outcomes for individuals with dementia and their caregivers in nursing homes: protocol for a systematic review and meta-analysis

Authors: Yu-Tai Lo, Yi-Jhen Chen, Jheng-Yan Wu, Chih-Cheng Lai

Journal: BMJ Open, 2024; 14:e088646

DOI: 10.1136/bmjopen-2024-088646

Type of Study

Protocol for a systematic review and meta-analysis

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PICO Summary

Population (P)

• Individuals with dementia residing in nursing homes, and their caregivers
• Includes adults aged 65+ with advanced cognitive decline, likely nearing end of life
• Reflects global populations, but special attention to studies in the US, UK, and Europe
• Also includes family caregivers as secondary population

Intervention (I)

• Advance Care Planning (ACP) programmes
  • May include:
    • Structured EoL conversations
    • Documentation of advance directives
    • Family-inclusive decision-making
    • Multicomponent ACP interventions (education, discussion, and documentation)

Comparison (C)

• Usual care (no formal ACP programme)
• May include informal or inconsistent EoL care planning

Outcomes (O)

Person-centred outcomes:

1. Quality of life (patient-focused)
2. Caregiver satisfaction

Process outcomes:

3. Advance directives completion rate (proportion with documented EoL preferences)

4. Uptake of ACP discussion (frequency of ACP conversations)

Health system outcome:

5. Comfort in the last week of life

• Captures alignment of care with patient wishes and symptom management 

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Findings Summary (Protocol Stage)

• No results yet: this is a protocol, not a completed review
• Will include RCTs and observational studies
• Designed using PRISMA-P, Cochrane methods, and GRADE certainty framework
• Aims to synthesise evidence across multiple EoL domains (clinical, emotional, communicative)
• Seeks to inform best practice guidelines and future ACP implementation strategies in long-term care settings

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