Here is the standardised PICO analysis for the thirtieth uploaded article:
Full Title
The Effect of Advance Care Planning Intervention on Hospitalization Among Nursing Home Residents: A Systematic Review and Meta-Analysis
Authors: Apiradee Pimsen, Chi-Yin Kao, Sheng-Tzu Hsu, Bih-Ching Shu
Journal: Journal of the American Medical Directors Association (JAMDA), 2022; 23:1448–1460
DOI: 10.1016/j.jamda.2022.07.017
Type of Study
Systematic Review and Meta-Analysis (9 included studies; 5 included in meta-analysis)
PICO Summary
Population (P)
- Nursing home residents
- Studies included residents aged 78–96 years, most with multiple comorbidities and moderate to severe cognitive impairment
- Total of 57,180 participants across 9 studies; 2587 included in the meta-analysis
Intervention (I)
- Advance Care Planning (ACP) interventions focused on:
- Discussing care preferences and hospitalization
- Providing educational tools or structured discussions (e.g., videos, decision aids, GOCP forms)
- Documenting preferences through advance directives, DNH/DNR orders, or structured ACP forms
- Delivered by nurses, physicians, geriatricians, or interdisciplinary teams
- Settings ranged across the USA, Canada, Australia, Finland, and Ireland
Comparison (C)
- Usual care, often not involving structured ACP processes or standardized materials
- Some pre-post studies had no comparator arm
Outcomes (O)
Primary outcome – Hospitalization:
- ACP significantly reduced the likelihood of hospitalization
- Risk Ratio (RR): 0.54
- 95% CI: 0.47–0.63
- Heterogeneity: I² = 0% → high consistency between studies (see forest plot on page 11)
Secondary outcomes:
- Emergency Department (ED) visits: No significant effect (RR 0.60; 95% CI: 0.31–1.42; I² = 99%)
- Hospice enrollment: No significant effect (RR 0.98; 95% CI: 0.88–1.10)
- Mortality: No significant difference (RR 0.83; 95% CI: 0.68–1.00)
- Satisfaction with care: No significant improvement (SMD –0.04; 95% CI: –0.14 to 0.06)
Findings Summary
This systematic review and meta-analysis demonstrated that ACP interventions in nursing homes significantly reduce hospitalisations but have no consistent effect on ED visits, hospice enrollment, mortality, or satisfaction with care. ACP implementation methods varied, but successful studies included structured discussions, educational sessions, and documentation of preferences. The review highlights the need for policy support to promote ACP in aged care and calls for further high-quality research to explore effects on broader health outcomes, especially in culturally diverse and lower-resource settings .
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