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Meta-Analysis
. 2023 Sep;66(3):e365-e398.
doi: 10.1016/j.jpainsymman.2023.05.001. Epub 2023 May 8.

Interventions to Promote End-of-Life Conversations: A Systematic Review and Meta-Analysis

Silvia Gonella  1 , Valerio Dimonte  2 , Ylenia Arnone  2 , Beatrice Albanesi  2 , Paola Berchialla  3 , Paola Di Giulio  2 , J T van der Steen  4
Affiliations
Meta-Analysis

Interventions to Promote End-of-Life Conversations: A Systematic Review and Meta-Analysis

Silvia Gonella et al. J Pain Symptom Manage. 2023 Sep.

Abstract

Context: Although several interventions aimed to promote end-of-life conversations are available, it is unclear whether and how these affect delivery of end-of-life conversations. Measuring the processes associated with high-quality end-of-life care may trigger improvement.

Objectives: To estimate the effect of interventions aimed to promote end-of-life conversations in clinical encounters with patients with advanced chronic or terminal illness or their family, on process indicators of end-of-life conversations.

Methods: Systematic review with meta-analysis (PROSPERO no. CRD42021289471). Four databases (PubMed, CINAHL, PsycINFO, and Scopus) were searched up to September 30, 2021. The primary outcomes were any process indicators of end-of-life conversations. Results of pairwise meta-analyses were presented as Risk Ratio (RR) for occurrence, standardized mean difference (SMD) for quality and ratio of means (ROM) for duration. Meta-analysis was not performed when fewer than four studies were available.

Results: A total of 4,663 articles were scanned. Eighteen studies were included in the systematic review and 16 entered at least one meta-analysis: documented occurrence (n = 8), patient-reported occurrence (n = 4), patient-reported-quality (n = 4), duration (n = 4). There was significant variability in settings, patients' clinical conditions, and professionals. No significant effect of interventions on documented occurrence (RR 1.54, 95% CI 0.84-2.84; I2 91%), patient-reported occurrence (RR 1.52, 95% CI 0.80-2.91; I2 95%), patient-reported quality (SMD 0.83, 95% CI -1.06 to 2.71; I2 99%), or duration (ROM 1.20, 95% CI 0.95-1.51; I2 65%) of end-of-life conversations was found. Data on frequency were conflicting. Interventions targeting multiple stakeholders promoted earlier and more comprehensive conversations.

Conclusion: Heterogeneity was considerable, but findings suggest no significant effect of interventions on occurrence, patient-reported quality and duration of end-of-life conversations. Nevertheless, we found indications for interventions targeting multiple stakeholders to promote earlier and more comprehensive conversations.

Keywords: Clinical encounter; conversations; end of life; meta-analysis; systematic review; terminally ill.

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