Interventions to Improve Advance Care Planning for Adults in Primary Care Settings: A Narrative Review.

Authors

Maree Fraser, Ella Ottrey, Gabrielle Hutchins, Alison Fitzgerald, Jaclyn Bishop

Published in

Journal of palliative medicine. Pages 10966218261476382. Aug 12, 2026. Epub Aug 12, 2026.

Abstract

An Advance Care Directive (ACD) allows a person to document their future health care wishes, guiding health care professionals in times when the person is unable to speak for themselves. In the United States, the Patient Self-Determination Act was passed into federal law in 1990, marking the beginning of the advance care planning movement in the United States. Despite ongoing efforts, ACD completion rates are poor, particularly among those coming into general practice. This narrative review sought to identify and synthesize community-based interventions designed to improve ACD completion rates to inform local approaches.
A narrative review using a systematic approach was conducted. Two databases-Ovid Medline and CINAHL-were searched for original research published in English between 2000 and January 2025. Titles/abstracts and full texts were independently reviewed by two authors for eligibility. Conflicts were resolved by a third author. Data were extracted from included articles and synthesized narratively to describe the interventions and their impact on ACD completion rates.
Database searches yielded 1200 articles, of which 40 studies were included. While studies were predominately from the United States, research was conducted in settings of varying size and employed diverse randomized, nonrandomized and quality improvement study designs. The interventions trialled targeted patients and/or primary care providers and commonly comprised a suite of complementary strategies that spanned education/training, resources/decision aids, system improvements/quality improvement activities, support/consults/visits, and reminders/prompts. The outcomes were predominately positive, with most studies showing improvements in ACD completion rates following the intervention.
There is increasing research interest and evidence for interventions supporting ACD completion rates among patients in primary care settings. Health care administrators and clinicians should consider and test which interventions or intervention components are most likely to drive higher completion rates in their local contexts. Further research is now needed to evaluate the extent to which interventions can enhance ACD completion rates in diverse countries and settings.

PMID:
42581738
Bibliographic data and abstract were imported from PubMed on 12 Aug 2026.

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