Advance Care Planning Interventions for Adults With Chronic Kidney Disease: A Systematic Review

Abstract

Background: Advance care planning enables adults to express their goals and preferences for future care. Advance care planning has been widely recognised in oncology and palliative care for decades, but its use in kidney care is variable. Objective: To examine interventions that promote advance care planning among adults with chronic kidney disease, including those receiving kidney replacement therapy. Design: Systematic review. Method: A comprehensive search was conducted in six databases: PubMed, MEDLINE, CINAHL, PsycINFO, Scopus, and Embase. Studies published from databases inception to September 2024 were included. Two independent reviewers identified studies for full-text review and data extraction. Methodological quality was assessed using the Mixed Methods Appraisal Tool. The review protocol was registered in PROSPERO (CRD42024589958). Results: Twenty-seven studies were included: 22 were quantitative (10 randomised and 12 non-randomised), three were qualitative, and two were mixed-methods designs. Most studies were conducted in the United States of America. Five main strategies to promote advance care planning uptake and improve outcomes were educating and training kidney healthcare professionals; implementing advance care planning conversations; providing educational resources; offering peer facilitators; and integrating palliative care teams. The synthesis of qualitative findings indicated that advance care planning discussions instilled hopefulness about the future and did not induce anxiety. Conclusion: Advance care planning conversations combined with educational resources and peer support facilitators are likely to improve rates of advance care planning completions in this population, although further evidence is needed. Kidney healthcare professionals should be trained to initiate these conversations with all patients.