Effectiveness of advance care planning decision aids for adults: a network meta-analysis of randomised controlled trials
Zhuolin Yang, Jingying Sun, Pingping Huang, Qing YangAims
To compare and rank the effectiveness of various advance care planning (ACP) decision aids in increasing the completion rates of ACP.
Background
ACP protects patient autonomy, eases caregiver burden and improves interdisciplinary communication. However, its implementation remains challenging. This study compares the effectiveness of various ACP support tools to promote clinical ACP implementation.
Designs
A systematic review and network meta-analysis.
Methods
We searched PubMed, Embase, the Cochrane Library, CNKI, Wanfang and VIP databases up to December 2025. Statistical analysis was performed using RevMan V.5.4 and Stata V.18.0.
Results
A total of 13 randomised controlled trials were ultimately included, covering eight types of support tools. The results of the network meta-analysis showed that, in terms of improving the rate of documentation of advance healthcare plans within the healthcare system, interventions using paper-based tools, video tools, electronic tools and various combined tools were more effective than usual care; paper-based tools ranked first in terms of the percentage of area under the cumulative ranking curve; in terms of increasing the signing rate of advance directives (AD) documents, personnel-supported interventions, motivational interviewing interventions and video tools were more effective than usual care; the intervention with the highest percentage of the cumulative ranked area under the curve was the personnel-supported intervention.
Conclusions
During the initial stages of ACP, paper tools are effective; during the signing of the AD document, personnel support interventions are more effective. In clinical practice, different tools should be selected based on the specific stage of the process to promote ACP.