Cochrane corner: advance care planning for adults with heart failure.

Advance care planning (ACP) is a process of discussing an individual’s values, life goals, and preferences of future medical care between individuals, their family members/surrogate decision makers and healthcare providers.1 The American Heart Association has highlighted the importance of implementing ACP for people with heart failure.2 However, the clinical course in heart failure is often unpredictable and it is thus challenging to predict the precise trajectory of the condition.2 This prognostic uncertainty together with the difficulties with identifying appropriate timing to initiate ACP as well as the general fear of depriving a person’s hope are just some of the barriers to implementing ACP.2 3 It is known that ACP could increase the likelihood of receiving end-of-life care according to an individual’s wishes and improve quality of communication among people with cancers or chronic diseases; however, the effects of ACP for people with heart failure are yet to be determined. Consequently, we conducted a Cochrane review to assess the outcomes of ACP in people with heart failure.4 A comprehensive literature search was performed to identify eligible randomised controlled trials (RCTs) investigating the effects of ACP as compared with usual care without any component of ACP among adults (≥18 years) with all types of heart failure. For the purpose of this Cochrane review, ACP is defined as a form of communication aimed at discussing individuals’ values and preferences, understanding their illnesses and prognosis, and goals regarding future medical care. Using comprehensive search strategies based on the keywords of ‘heart failure’, ‘advance care planning’, ‘living will’, ‘terminal care’, ‘shared decision making’ and ‘statement of wishes’ (full strategies are illustrated in our Cochrane review),4 we searched the Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, EMBASE, MEDLINE, Social Work Abstracts, as well …