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A review of clinical trials of advance care planning interventions adapted for limited health literacy

Published online by Cambridge University Press:  27 August 2021

Mary Clare K. Houlihan Open the ORCID record for Mary Clare K. Houlihan [Opens in a new window] ,
Masako Mayahara ,
Barbara Swanson  and
Louis Fogg
Mary Clare K. Houlihan*
Affiliation:
College of Nursing, Rush University, Chicago, IL
Masako Mayahara
Affiliation:
College of Nursing, Rush University, Chicago, IL
Barbara Swanson
Affiliation:
College of Nursing, Rush University, Chicago, IL
Louis Fogg
Affiliation:
College of Nursing, Rush University, Chicago, IL
*
Author for correspondence: Mary Clare Houlihan, Rush University, 600 S Paulina St., #1080, Chicago, IL 60612, USA. E-mail: [email protected]
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Abstract

Objectives

Advance care planning is vital for ensuring individuals receive end-of-life care that is consistent with their care preferences and improves patient quality of life and satisfaction with care; however, only 11% of Americans have discussed advance care planning with a healthcare provider. Individuals with limited health literacy are even less likely to participate in advance care planning due to difficulty comprehending complex health information. The purpose of this review was to identify randomized controlled trials designed to address the effects of limited health literacy on advance care planning, evaluate the quality of these studies, and summarize evaluation data to inform future studies.

Methods

This systematic review examined randomized controlled trials published from January 1997 to July 2020 using the PubMed, CINAHL, PsycINFO, and Scopus databases. Data were extracted and two reviewers independently evaluated the quality of studies using the Joanna Briggs Institute Critical Appraisal Tool.

Results

The database search yielded 253 studies and five studies were included in the final review. Studies were conducted in mostly White patients in outpatient clinics in the United States. Researchers wrote text at lower reading levels, added images to materials, and created videos to enhance communication. Health literacy interventions increased participant knowledge, preference for comfort care, engagement, and care documentation; however, several methodological issues were identified, including baseline differences in treatment and control groups, issues with blinding, lack of valid and reliable outcome measures, and inappropriate statistical analyses.

Significance of results

More high-quality intervention studies that address the effects of limited health literacy on advance care planning in diverse populations and settings are needed. Future intervention studies should use reliable and valid instruments to measure advance care planning outcomes. Clinicians should use materials appropriate for their patients’ health literacy levels to address their advance care planning needs.

Keywords

Advance care planningCritical appraisalHealth literacyRandomized controlled trialsReview
Type
Review Article
Information
Palliative & Supportive Care , Volume 20 , Issue 4 , August 2022 , pp. 593 - 599
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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