Prevalence and Moderating Factors of Advance Care Planning: A Systematic Review and Meta-Analysis

Abstract

Objective

To provide a comprehensive overview of the global prevalence of Advance Care Planning (ACP) and its moderating factors through a systematic review and meta-analysis.

Data Source

PubMed, Scopus, and Cochrane Library databases were searched for studies reporting ACP prevalence up to December 31, 2023.

Study Inclusion and Exclusion Criteria

Eligible studies included prospective and retrospective cohort studies, cross-sectional surveys, and randomized controlled trials (RCTs). Only English-language studies were considered. RCTs reporting prevalence in control or pre-intervention arms were included.

Data Extraction

Two reviewers independently evaluated studies using Rayyan software. Data extracted included article characteristics, population characteristics, ACP prevalence, and potential moderating factors.

Data Synthesis

A random-effects meta-analysis model estimated ACP prevalence. Univariate meta-regressions and multimodel inference explored potential moderators. Subgroup analyses were conducted based on populations and settings.

Results

92 studies involving 7 839 271 individuals were included. The overall meta-analytic estimate of ACP prevalence was 0.39 (95% CI: 0.32-0.46), adjusted to 0.09 after accounting for publication bias. Significant moderators included the proportion of oncologic patients and white ethnicity. ACP prevalence was lower in acute disease populations compared to chronic disease and general populations.

Conclusion

ACP prevalence is low and stationary over time, potentially overestimated in chronic disease contexts. Facilitators such as supportive policies, public and professional education, and adaptive ACPs should be investigated to enhance ACP adoption.