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Review
. 2020 Mar 6;19(1):27.
doi: 10.1186/s12904-020-0535-1.

Underlying goals of advance care planning (ACP): a qualitative analysis of the literature

Nienke Fleuren  1 , Marja F I A Depla  2 , Daisy J A Janssen  3   4 , Martijn Huisman  5   6 , Cees M P M Hertogh  2
Affiliations
Review

Underlying goals of advance care planning (ACP): a qualitative analysis of the literature

Nienke Fleuren et al. BMC Palliat Care. .

Abstract

Background: Since the introduction of the concept of advance care planning (ACP), many studies have been conducted exploring beneficial effects. These studies show a heterogeneity in clinical endpoints, which reflects diversity of goals connected to ACP. This study aims to get insight in the range of underlying goals that comprise the legitimacy of ACP.

Methods: Systematic literature search in PubMed, EMBASE, PsychInfo, CINAHL and Cochrane Library. Articles on normative aspects of ACP were included, based on title and abstract. Due to the quantity of inclusions, of which many had similar content, purposive sampling was used to select articles for full text document analysis. Analysis stopped once saturation was reached.

Results: In total, 6497 unique articles were found of which 183 were included. Saturation was reached after document analysis of 55 articles (30%); this yielded 141 codes concerning goals of ACP and also 70 codes about objections against ACP, which shed light on the underlying goals of ACP as well. We identified five underlying goals: respecting individual patient autonomy, improving quality of care, strengthening relationships, preparing for end-of-life, reducing overtreatment.

Conclusions: Five distinctive underlying goals of ACP were identified, each with corresponding objections that need to be considered. Specifying underlying goals of ACP may direct the debate on definitions, methods and preferred outcomes of ACP. This study was funded by the Netherlands Organisation for Health Research and Development, grant 839120002.

Keywords: Advance care planning; Autonomy; End-of-life; Goals of care; Quality of care; Relationships.

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Conflict of interest statement

All authors have completed the Unified Competing Interest form and declare: this study was funded by the Netherlands Organisation for Health Research and Development, grant 839120002; no other financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years, no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig. 1
Fig. 1
Flow chart for literature search and selection of articles
Fig. 2
Fig. 2
Cumulative amount of codes about goals and objections of ACP during the analyzing process
See this image and copyright information in PMC

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