Systems for electronic documentation and sharing of advance care planning preferences: a scoping review

Figures & data

Figure 1. PRISMA flowchart for identification, screening, and inclusion of studies.

Table 1. Summary of included studies.

Author(s)	Year	Country	Study design	Population and sample size (n)	Description of system(s) involved	Name of system being described
Auret et al.	2019	Australia	Quantitative (observational)	N = 73 (Physicians (n = 26), nurses (n = 15) other HCPs (n = 12), audit of patients (n = 20))	EHR	NA
Brungardt et al.	2019	USA	Quantitative (observational)	N = 105 (patients)	EHR	My Health Connection
Fin et al.	2016	USA	Quantitative (observational)	N = 900 (people who were users of the MyDirectives platform)	Standalone system not involving an EHR	MyDirectives
Goodwin et al.	2021	New Zealand	Other	N = 3,238 (The findings were obtained from an analysis of a database of 3238 people who had finalised an AC Plan between December 2013 and December 2019.)	EHR	eAC Plans
Hall et al.	2012	UK (Scotland)	Qualitative	N = 22 (purposive sampling of practice nurses (3 interviews), GPs (12 interviews), a practice manager (1 interview) from practices using different computing software systems and patients and/or carers (6 interviews for whom an ePCS had been completed))	EHR	Electronic Palliative Care Summaries (ePCSs)
Halpert et al.	2021	USA	Quantitative (observational)	N = 426 (patients aged 75 years or older who had an upcoming appointment with their provider within 2 weeks and who had no documentation of ACP in their chart)	EHR	Epic EMR, which includes an ACP activity tab
Harrington et al.	2020	UK (England)	Mixed	N = 159 (data on gerontology inpatients (n = 133) with electronic do not attempt cardiopulmonary resuscitation (e-DNACPR) decisions and survey data from staff (n = 26) including senior and junior doctors, and medical trainees)	EHR	NA
Holt et al.	2019	USA	Other	NA	Standalone system not involving an EHR	Oregon’s online registry of out-of-hospital DNR orders
Jordan et al.	2019	USA	Qualitative	N = 46 (patients, mean age: 49, 63% female)	EHR	My Health Connection
Klugman et al.	2013	USA	Quantitative (observational)	N = 371 (platform users)	Standalone system not involving an EHR	TexasLivingWill.org (TLW), NVLivingWill.com (NVLW)
McDarby et al.	2021	USA	Other	NA	Other	ACP Tools (iOS and Android) BIDMC Health Care Contingency Plan – Personal MedStar CR My Dot Mediq My Directives My Health Proxy My Living Will Paper Health
Millington-Sanders et al.	2012	UK	Quantitative (observational)	N = 597 (patients)	Standalone system not involving an EHR	Coordinate My Care (CMC)
Mills et al.	2021	Australia	Mixed	N = 170 (Medical, nursing, and allied health practitioners working in palliative care)	Standalone system not involving an EHR	MyHealth Record
Moses et al.	2020	USA	Other	NA	EHR	NA
Nakagawa et al.	2014	USA	Quantitative (observational)	N = 93 (patients)	EHR	NA
Neubauer et al.	2015	USA	Quantitative (observational)	N = 5,467 (patients)	EHR	My Choices, My Wishes
Obel et al.	2014	USA	Quantitative (observational)	N = 48 (patients)	EHR	NA
Portz et al.	2020	USA	Quantitative (observational)	N = 3292 (UCHealth patients who interacted with the My Health Connection patient portal, advance care planning tools, specifically by completing an electronic MDPOA form or sending an electronic message to the advance care planning support team)	EHR	My Health Connection
Portz et al.	2020	USA	Qualitative	N = 24 (participants from the KPCO EMR with inclusion criteria included: ≥65 years of age, KPCO member for ≥ 1 year, presence of multiple chronic conditions (Charlson Comorbidity Index > 2), and a patient with one of the participating KPCO study clinics)	EHR	My Health Manager (Kaiser Permanente Colorado’s (KPCO) patient portal)
Reidy et al.	2017	USA	Mixed	N = 27 (hospitalists, residents, and nurse practitioners on conducting goals-of-care conversations – although other survey work also outlined)	EHR	Luminat
Riley et al.	2013	UK (England)	Other	NA	Standalone system not involving an EHR	Coordinate My Care
Rolnick et al.	2021	USA	Quantitative (experimental)	N = 91 (Adults with gastrointestinal and lung malignancies were recruited from the Penn Medicine Infusion Center. 46 randomly allocated to the web AD and 45 to paper)	EHR Plus	Our Care Wishes
Saiki et al.	2017	USA	Other	NA	EHR	Goals of Care template, as part of TEAM approach (Time, Education, Assessment, and Management)
Seecof et al.	2022	USA	Other	N = 50 (Patients at the Center for Healthy Aging aged 65 or older without documented ACP in the EMR)	EHR	NA
Serrano-Eanelli et al.	2019	USA	Other	N = 331 (medical records of patients)	EHR Plus	New York State eMOLST (electronic Medical Order for Life-Sustaining Treatment form)
Seuli Bose-Brill et al.	2016	USA	Quantitative (experimental)	N = 50 (patients)	EHR Plus	MyChart
Shervin Esfahani et al.	2020	USA	Other	N = 365 (Retrospective record review of all ICU deaths across the system in 1 year)	EHR	SmartPhrase (a tool in the Epic EMR system)
Stepan et al.	2019	USA	Other	N = ∼15,600 (patient records of all new patients with a diagnosis of advanced or metastatic cancer who had a documented advance directive and/or ACP conversations with an ambulatory care provider (physicians, fellows, residents, physician assistants, nurse practitioners, nurses, social work counsellors, and chaplains) by their third office visit)	EHR	NA
Tieu et al.	2017	USA	Quantitative (observational)	N = 200 (patients within the Division of Primary Care Internal Medicine, aged 65 and older, with access to the secure PEM system and without an AD on file, were included for randomization)	EHR Plus	Mayo Clinic Patient Online Services system
Walker et al.	2018	USA	Quantitative (observational)	N = 414 (primary care patients at the San Francisco Veterans Affairs Medical Center, were $60 years old, and had $2 chronic/serious health conditions)	EHR	Prepare for your care (www.prepareforyourcare.org)
Wilson et al.	2020	USA	Other	NA	EHR	Epic Systems EMR
Wu et al.	2022	USA	Quantitative (observational)	N = 187,690 (unique patients 65 years and older with at least one clinical encounter at an SHC outpatient clinic over the study period)	EHR	Epic Systems
Wye et al.	2016	UK	Mixed	N = 3,594 (Data from 1,022 North Somerset and 2,572 Somerset palliative patients; interview participants = 101 professionals, 49 by telephone, 29 face to face and 23 informally)	EHR	Adastra
Zive et al.	2016	USA	Other	NA. Intended for those nearing end of life.	EHR	ePOLST

Key: EHR = Electronic Health Record; EMR = Electronic Medical Record; NA = Not applicable.

Data availability statement

The review was conducted using data that were already available in the public domain, with appropriate references provided throughout. The full search strategy used in the present review can be found in the supplementary material.