First author | Citation | Sample | Aim | Research methods used | Key Findings | Weight of Evidence* |
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Black22 | J Gerontol Soc Work 2004;43:13 1–46 | 29 social workers in 6 hospitals in upstate New York, US. | To examine social workers’ advance directive communication with hospitalised elderly patients | Questionnaire |
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Black27 | Home Health Care Serv Q 2007;26:41–58 | 27 case managers across Florida, US | To explore case managers perceptions of facilitators and barriers to advance care planning practices. | Focus groups |
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Bradley10 | J Am Geriatr Soc 1998;46:12 35–41. | 600 residents admitted between 1990 and 1994 to 6 nursing homes in Connecticut, US | To measure the frequency nursing home residents discuss with clinicians their wishes for future treatment and to assess the influence of the PSDA. | Review of nursing home medical records |
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Carrese21 | Brit Med J 2002;324:1 25–7 | 20 chronically ill housebound patients over 75 from Baltimore US | To understand how elderly patients think about and approach future illness and the end of life. | Semi-structured interviews. |
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Clarke34 | J Pain Symptom Manag 2010;40:85 7–69 | 74 people older people, informal caregivers and community group representative s from across UK | To explore older people’s concerns about end-of-life issues. | Focus groups |
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Damato11 | N J Med 1993;90:21 5–20. | 86 community-dwelling senior citizens from Jersey City, US | To determine knowledge and interest in advance directives and attitudes towards end of life care. | Questionnaire |
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Froggatt35 | Palliative Med 2009;23:33 2–8 | 213 managers of care homes in North West and South West England | To describe current Advance Care Planning practices in English care homes for older people. | Questionnaire and telephone interview |
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Gamble12 | Arch Intern Med 1991;151:2 77–80. | 75 elderly people in rural eastern North Carolina | To explore the knowledge, attitudes and behaviour of elderly persons regarding living wills. | Questionnaire |
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Golden17 | Am J Hosp Palliat Care 2009;26:13–7. | 1569 home-bound but nursing home eligible older adults in Florida. | To study the prevalence of specific barriers that prevent home-bound older adults from obtaining advance directives. | Interviews |
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Gordon13 | Arch Intern Med 1999;159:7 01–4. | 5117 people aged over 65 years. | To find the proportion of seniors who had been asked about their end of life care preferences by a clinician & had completed an advance directive | Questionnaire |
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Johnston28 | Arch Intern Med 1995;155:1 025–30. | 329 adults age 19 to 94 years 282 resident & 272 practicing physicians at 8 primary care clinics across Eastern and Mid-Western US | To assess the opinions of Primary Care Patients and Physicians on discussions on Advance Directives | Questionnaire |
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Malcomson14 | J Am Acad Nurse Pract 2009;21:18–23. | 20 healthy 60–94 year olds Massachusetts US | To explored the perspective of healthy elders to advance care planning. | Focus groups & questionnaire. |
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Markson23 | J Am Geriatr Soc 1997;45:39 9–406. | 653 physicians across US | Investigates how much experience physicians have had discussing and following advance preferences and how physicians perceive their role in the advance decision making process | Questionnaire |
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McCarth15 | J Geront A-Biol 2008;63:95 1–9. | 220 community dwelling elders all over 80 years old US | To describe advance care planning, health care preferences and health perceptions in a very elderly sample. | Interview |
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Moore16 | J Gerontol Soc Work 1999;31:21–39. | 20 low income community dwelling senior adults in relatively good health age 58–78 years in New York State US | To explore factors that influence an elder’s decision to complete an advance directive | Interview |
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Morrison24 | Arch Intern Med 1994;154:2 311–8. | 277 residents and attending physicians at a large New York Hospital, US | To determine the impact of five proposed barriers to physicians using advance directives. | Questionnaire |
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Palker18 | Nurse Pract 1995;20:7–8, 13, 17–8, passim. | 104 nursing home residents, South Eastern US | To determine the prevalence of advance directives among residents of a Nursing Home, to identify barriers to documentation and to explore death anxiety. | Review of nursing home records plus interview with 17 residents |
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Pfeifer29 | J Gen Intern Med 1994;9:82–8. | 43 primary care physicians and 47 ambulatory patients in 8 cities across US | To identify primary care patients and physicians attitudes to discussions of end of life medical care. | Interviews. |
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Samsi31 | Health Soc Care Comm 2011;19:52–9. | 37 adults over 50 years in UK | To explore experiences, opinions and attitudes of older adults living in community in the context of the Mental Capacity Act. | Interviews |
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Schonfeld25 | Am J Hosp Palliat Care 2012;29:26 0–7. | Primary care physicians at University of Nebraska Medical Centre, Canada | To explore differences between end-of-life conversations with patients /families with multiple co-morbidities versus a single, terminal diagnosis. | Focus groups |
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Seymour26 | Soc Sci Med 2004;59:57–68. | 32 individuals from older people’s community groups in Sheffield UK | To explore older people’s views on advance statements and the role these might play in end of life care decisions. | Focus groups |
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Stelter19 | Arch Intern Med 1992;152:9 54–9. | 214 people over 65 years attending senior centres in Midwest US. | To learn the reasons why so few people had completed living wills | Questionnaire |
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Stewart20 | Age Ageing 2011;40:33 0–4. | Staff & families from 34 homes for older people in London, UK. | To explore views on advance care planning in care homes for older people. | Interviews |
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White32 | J Am Acad Nurse Pract 2005;17:14–20. | 13 new residents at a long-term care facility who had signed an advance directive in Midwest US. | Explore experiences of residents who had signed an advance directive on admission to a long-term care facility and apply author developed model. | Interviews |
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Winland-Brown33 | Adv Pract Nurs Q 1998;4:36–40. | 17 people over 65 with no formal advance directive Florida, US | To understand older people’s reasons for not having formalized their end-of-life decisions. | Interview |
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Zronek30 | JONAS Healthc Law Ethics Regul 1999;1:23–8. | 51 people over 60 years with an advance directive prior to hospital admission in Mid-West US | To examine patients’ beliefs and level of understanding of the advance directives they had completed. | Survey |
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↵* Gough’s “Weight of evidence criteria”
Papers are assessed on four criteria:
1. Coherence & integrity of the evidence in its own terms
2. Appropriateness of form of evidence for answering review question
3. Relevance of the evidence for answering review question
4. Overall assessment of study contribution to answering review question (low, medium or high)
Criteria 1 involved an attempt to assess the risk of bias within individual studies. The weightings of each paper are shown in the final column of Table 1 with the weighting given for overall assessment of study contribution (criterion 4) in bold.