Association Between End-of-Life Conversations in Nursing Homes and End-of-Life Care Outcomes: A Systematic Review and Meta-analysis

Silvia Gonella; Ines Basso; Valerio Dimonte; Barbara Martin; Paola Berchialla; Sara Campagna; Paola Di Giulio

doi:10.1016/j.jamda.2018.10.001

Association Between End-of-Life Conversations in Nursing Homes and End-of-Life Care Outcomes: A Systematic Review and Meta-analysis

J Am Med Dir Assoc. 2019 Mar;20(3):249-261. doi: 10.1016/j.jamda.2018.10.001. Epub 2018 Nov 20.

Authors

Silvia Gonella¹, Ines Basso², Valerio Dimonte³, Barbara Martin⁴, Paola Berchialla⁵, Sara Campagna², Paola Di Giulio²

Affiliations

¹ Department of Biomedicine and Prevention, University of Roma Tor Vergata, Roma, Italy; Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy. Electronic address: silvia.gonella@unito.it.
² Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy.
³ Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy; Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy.
⁴ Research and Third Mission Area, University of Torino, Torino, Italy.
⁵ Department of Clinical and Biological Sciences, University of Torino, Torino, Italy.

PMID: 30470575
DOI: 10.1016/j.jamda.2018.10.001

Abstract

Objective: Less aggressive end-of-life (EOL) care has been observed when health care professionals discuss approaching EOL and preferences about life-sustaining treatments with nursing home (NH) residents or their families. We performed a comprehensive systematic review to evaluate the association between health care professionals-residents and health care professionals-family EOL conversations and EOL care outcomes.

Design: Systematic review with meta-analysis.

Setting and participants: Seven databases were searched in December 2017 to find studies that focused on health care professionals-residents (without oncologic disease) and health care professionals-family EOL conversations and aimed to explore the impact of EOL conversations on resident's or family's EOL care outcomes.

Measures: Random effects meta-analyses with subsequent quality sensitivity analysis and meta-regression were performed to assess the effects of EOL conversations on the decision to limit or withdraw life-sustaining treatments. A funnel plot and Eagger test were used to assess publication bias.

Results: 16 studies were included in the qualitative and 7 in the quantitative synthesis. Health care professionals-family EOL conversations were positively associated with the family's decision to limit or withdraw life-sustaining treatments (odds ratio = 2.23, 95% confidence interval: 1.58-3.14). The overall effect of health care professionals-family EOL conversations on the family's decision to limit or withdraw life-sustaining treatments remained stable in the quality sensitivity analysis. In the meta-regression, family members with a higher level of education were less influenced by EOL conversations with health care professionals when making decisions about limiting or withdrawing life-sustaining treatments. No publication bias was detected (P = .4483).

Conclusions/implications: This systematic review shows that EOL conversations promote palliative care. Structured conversations aimed at exploring NH resident preferences about EOL treatment should become routine. NH administrators should offer health care professionals regular training on EOL conversations, and resident-centered care that involves residents and their families in a shared decision-making process at EOL needs to be promoted.

Keywords: Communication; conversation; end of life; life-sustaining treatment; meta-analysis; nursing home; systematic review.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Communication*
Humans
Nursing Homes*
Palliative Care*
Terminal Care*