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Review
. 2025 Apr 16;17(4):e82403.
doi: 10.7759/cureus.82403. eCollection 2025 Apr.

Effects of Advance Care Planning on the Mental Health of Bereaved Families: A Systematic Review

Michihiro Tsubaki  1 , Hideaki Aoyagi  1 , Yoshiyasu Ito  2 , Masahiro Kobayashi  3 , Ai Ushiwata  4
Affiliations
Review

Effects of Advance Care Planning on the Mental Health of Bereaved Families: A Systematic Review

Michihiro Tsubaki et al. Cureus. .

Abstract

Decisions regarding end-of-life care are often made by surrogate decision makers, such as family members. These decisions can place a significant psychological burden on surrogates, especially when the patients' wishes are unclear. Advance care planning (ACP) is a patient-centered preconsultation process that is expected to improve the mental health of surrogate decision-makers. This study aimed to clarify the impact of ACP intervention on the mental health of bereaved families and verify its effectiveness. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, EMBASE, PsycINFO, and Cochrane Central Register of Controlled Trials were searched for studies evaluating ACP interventions published up to 2024. Studies were independently selected by two researchers using the Covidence systematic review software (Veritas Health Innovation, Melbourne, Australia). The inclusion criteria were (i) studies evaluating the effectiveness of ACP interventions, (ⅱ) studies reporting bereaved mental health outcomes, and (ⅲ) randomized controlled trials (RCTs). Among the 2,025 studies initially identified, 12 RCTs were included. All interventions involved health professionals trained to facilitate ACP discussions before the patient died. Mental health was assessed using depression, anxiety, and posttraumatic stress disorder scales. The items for which significant differences were reported varied among the studies, but several studies reported effectiveness in treating depression in bereaved families. Furthermore, when baseline-adjusted results were included, ACP interventions reduced post-bereavement anxiety and stress experienced by families. In conclusion, depending on the targets and intervention methods, pre-death discussions may improve the mental health of bereaved families. Thus, ACP should be implemented to help bereaved families.

Keywords: advance care planning (acp); bereaved families; end-of-life care; mental health; surrogate decision-makers; systematic review.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: The research, writing, and publication of this paper have been supported by the following grant: Japan Society for the Promotion of Science (grant number: JP21K17428). Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart of the study selection process
The figure was created by the authors using Covidence (https://www.covidence.org/).
Figure 2
Figure 2. Study quality assessment using the Cochrane risk-of-bias tool for randomized trials
The image was created by the authors using robvis (https://www.riskofbias.info/welcome/robvis-visualization-tool).
Figure 3
Figure 3. Random-effects model for each outcome
The image was created by the authors using R version 4.3.3 (https://www.r-project.org/?2827).
See this image and copyright information in PMC

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