Advanced Care Planning (ACP) in the early phase of COVID-19: A rapid review of the practice and policy lessons learned

Abstract

AbstractThis rapid review of quantitative and qualitative publications of any design indexed in PUBMED between January 2020-April 2021 investigates barriers and enablers of advancecare planning (ACP) worldwide in the early stages of the life-threatening COVID-19 pandemic. Seventy-four papers were included: 35 primary research studies (cohorts, reviews, case studies, and cross-sectional designs) and 39 commentaries. Publications from hospitals, outpatient services, aged care and community indicated widespread interest in accelerating ACP documentation to facilitate management decisions and goal-aligned care. Enablers of ACP included targeted public awareness, availability of telehealth, access to online tools and a person-centered approaches. Barriers included uncertainty regarding clinical outcomes, cultural or communication difficulties, legal and ethical considerations, infection control restrictions, lack of time, and limited resources and support systems. The opportunities for rapid implementation of ACP offered by the social distancing restrictions and high demand for health services are valuable in informing future policy and practice.What this paper addsOur study adds to existing evidence by identifying emerging barriers and creative ways of overcoming them in response to a global crisisDiscussions on death prospects and care of the dying were feasible and a step towards normalisation of advance care planningDespite new and overwhelming challenges, policies and practices could be rapidly implemented to satisfy clinicians and families in need of advance care planningApplications of study findingsThe lessons learnt can be incorporated in future health service planning since the threat of other pandemics is realA formal evaluation of effectiveness of some of the emerging strategies would be a valuable addition to the evidence