Healthcare professionals' perceptions and experiences of implementing advance care planning for terminal patients: a systematic review and Meta-integration

Published: 8 April 2022| Version 1 | DOI: 10.17632/62p3n5zzd6.1


This is a systematic review. All data is contained in the following five files: 1) Fig.1 is the search flow diagram; 2)Table 1 is the critical appraisal of the studies included; 3)Table 2 is the data collection of included studies; 4)Table 3 is the CERQual assessment of each study; 5)Supplementary file is the process of outcomes' synthesis. What's more, this review protocol was registered at PROSPERO, the register number is CRD42022299229. If you're interested in it ,then you can click this website to find it.


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1) Search Strategy We searched the Web of Science, EMBASE, PubMed, MEDLINE, PsycINFO, CNKI, Wanfang, and SinoMed databases from the database establishment to October 27, 2021. The database selected was considered the most helpful in identifying peer-reviewed articles related to the topic. Our search model combined MeSH terms with free-text words. e.g. Web of science search formula: ("advance care planning" OR "advance directive" OR "advance medical directive" OR "living wills")AND ("terminal patient*" OR "end-stage patient*" OR "advanced patient*"AND ("healthcare professional*" OR "healthcare worker*" OR "nurse*" OR "nursing staff*" OR "doctor*")AND ("qualitative research*" OR "qualitative study*" OR "interview*" OR "mixed method*" OR "experience*" OR "qualitative phenomenon*" OR "attitude*). 2) Inclusion and exclusion criteria We set the requirements for inclusion according to the PICo-D principles: (i) study population: formal hcps(healthcare professionals) in long term care settings; (ii) phenomenon of interest: hcps' perceptions and experiences of ACP on terminal patients; (iii) study context: knowledge or previous experience of ACP implementation; (iv) study design: qualitative studies or qualitative studies as part of mixed methods studies. Exclusion criteria: (i) no full text; (ii) duplicate publications; (iii) not in Chinese or English. 3) Study screening Two evidence-based trained researchers carried out study screening independently. Another researcher check and consultation with a superior investigator assisted in judgment in case of disagreement. The retrieved studies were first imported into Zotero to remove duplicates, followed by reading the titles to exclude non-compliant literature, then reading the abstracts for initial screening, and finally reading the full text for re-screening. 4) Quality appraisal In this review, the quality of each included study was evaluated using the JBI Qualitative Appraisal Instrument, which consists of 10 items. Each item is assessed with a "yes," "no," or "unclear." The quality grade was evaluated as A when all ten things were "yes," B when they were partially met "yes," and C when all of them were not met "yes". 5) Data analysis The integration method used in this review is the thematic synthesis, which applies to the synthesis of evidence from various types of qualitative studies. The software NVivo 12 was used to analyze included studies thematically. 6)Confidence appraisal of review findings We will use CERQual (Confidence in the Evidence from Reviews of Qualitative Research) to assess the confidence that we may place in review findings. This approach has been developed by the GRADE Working Group (Lewin et al., 2018). This approach includes the following four components: methodological limitations, relevance; coherence; and adequacy. We used the JBI Qualitative Appraisal Instrument in this review to assess the methodological limitations.


First Affiliated Hospital of Nanchang University


Systematic Review