The Effectiveness of Advance Care Planning Training for Care Home Staff: a Systematic Review

In line with population ageing, the number of global deaths is predicted to increase. There have been projections that, within the next 20 years, in England and Wales, care homes may become the most common place of death. In order to respect the autonomy of their residents, it is therefore, vital that care home staff are able to have Advance Care Planning conversations. However, care home staff may lack the knowledge or confidence to have such discussions. Further, a systematic review found a paucity of evidence about whether Advance Care Planning training interventions for care home staff are effective. New, higher quality studies are now available, justifying this review update. We sought to address two questions: 1) ‘What Advance Care Planning education interventions exist for care home staff?’ and 2) ‘how effective are these interventions?’ All measurable outcomes of effectiveness (e.g. health system/resource-related, patient/relative-related, staff-related) including both qualitative and quantitative measures of effectiveness were considered. Design The review adheres to the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) and is registered on PROSPERO (ID: CRD42022337865). Original research evaluating Advance Care Planning education for care home staff and reporting any measurable outcome of effectiveness was included. We searched Ovid Medline All, Ovid Embase, Cochrane Central Register of Controlled Trials, EBSCO CINAHL, EBSCO ERIC, and Ovid PsycINFO from March 2018 (3 months prior to original review search cut-off) to June 2022, with supplemental journal and website searches. The results were synthesised by narrative synthesis. Findings The current review update almost doubled the number of included studies in a relatively short period. This review includes 10 studies (n = 310 care homes), from the UK, Belgium, Norway and Canada. UK studies were mainly related to the Gold Standard Framework for Care Homes. Two studies adopted multi-component education interventions. Outcome measures included resident/family, staff and health service-related concepts. Even after identifying a further 5 papers, there remains insufficient evidence to determine the effectiveness of Advance Care Planning education interventions for care home staff. Conclusions Advance Care Planning education interventions are heterogeneous and often complex in their design, flexibility, target populations, and outcomes. There remains insufficient data to determine the effectiveness of Advance Care Planning education interventions for care home staff, with a particularly urgent need to agree on outcome measures of the effectiveness. Future research could consider updating the existing Delphi consensus on outcome measures for evaluating Advance Care Planning, in light of this systematically collected evidence, with a view to agreeing outcomes that are specific to Advance Care Planning education interventions for care home staff. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Victoria Barber-Flemings post was funded by the Legal & General Group (research grant to establish the independent Advanced Care Research Centre at University of Edinburgh). The funder had no role in conduct of the study interpretation or the decision to submit for publication. The views expressed are those of the authors and not necessarily those of Legal & General. Mala Manns posts is supported by Marie Curie Cancer Care core grant funding (grant reference: MCCC-FCO-11-C) and by Wales Cancer Research Centre (grant reference: WCRC514031 ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Not relevant as this is a systematic review