Here is the structured PICO analysis for the eighteenth article you uploaded:
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Full Title (verbatim and exact):
“The effects of advance care planning intervention on nursing home residents: A systematic review and meta-analysis of randomised controlled trials”
Ng AYM, Takemura N, Xu X, Smith R, Kwok JYY, Cheung DST, Lin CC
International Journal of Nursing Studies (2022); 132:104276
DOI: https://doi.org/10.1016/j.ijnurstu.2022.104276
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Type of Article:
Systematic review and meta-analysis of randomised controlled trials
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PICO Analysis:
Population:
- Nursing home residents, including frail older adults and those with advanced dementia
- Total participants: 2905 residents across 9 included studies from the USA, UK, Australia, Norway, and the Netherlands
- Mean ages ranged from ~60 to 87 years; most participants were female
Intervention:
- Advance care planning (ACP) interventions involving:
- Formal education or training for staff (nurses, social workers, care coordinators)
- Structured ACP conversations with residents and/or proxies
- Use of videos, leaflets, scripts, or case conferencing
- Duration varied: some lasted 6 weeks, others up to 18 months
- Delivery models included both train-the-trainer and direct facilitation
Comparator:
- Usual care or informational control (e.g., unrelated written materials or non-ACP video)
- Control groups received no structured ACP intervention
Outcome:
1. Person-centred outcomes:
- Documentation of end-of-life care preferences:
- ACP interventions significantly increased documentation
- Pooled OR = 1.95 (95% CI: 1.64 to 2.32)
- Moderate heterogeneity (I² = 33.1%)
- Family satisfaction with end-of-life care:
- No significant effect observed
- Pooled SMD = 0.08 (95% CI: –0.08 to 0.23)
- Substantial heterogeneity (I² = 53.8%)
2. Process outcomes:
- Concordance between care preferences and delivered care:
- Improved in two of three trials; control group more likely to receive discordant care in one study
- ACP discussion prevalence and directive completion:
- ACP significantly increased completion of advance directives in most studies
- Use of healthcare services:
- Mixed results: one trial reported reduced hospitalisation, another found no significant difference
3. Health system outcomes:
- Healthcare utilisation:
- One study found lower hospitalisation and fewer hospital days (Molloy et al., 2000)
- No consistent reduction across all studies
- Cost-effectiveness not formally evaluated but implied as a potential benefit
Summary Conclusion:
This comprehensive meta-analysis concludes that ACP interventions in nursing homes are effective in improving documentation of end-of-life care preferences, though they do not significantly improve family satisfaction with care. Most studies incorporated staff education and structured discussions. The review underscores the need for better designed trials, including validated outcome measures, broader geographic representation (no studies from Asia), and exploration of cost-effectiveness. Despite heterogeneity, the findings support the inclusion of ACP as standard practice in residential aged care settings to honour residents’ care preferences and potentially optimise resource use.
Life In The Slower Lane 
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