The review article clearly defines the aim of the paper. It is mentioned that this review is written so that it can be found out whether written advance care plan leads to expected outcomes and results for the end of life patients living in aged care institution or facilities or not. The rationale for the study is also clearly highlighted that it will help the residents in decision making while they are forming advance care documents which will guide their own care which they will be receiving in the future. The author has described the aged care facility and its advantages. However, statistical data could be also being represented in the section of introduction which would tell about the percentage of people who are actually receiving this kind of help in the aged care facilities. The author has also stated about prevalence data for advance care planning but has not shown any data. The author has very nicely mentioned about present contradictions which are raised for the issue of advance care planning but more evidence could be presented for the benefits of this kind of planning so that a balance could be created in the section.
The potential benefit of the review was stated by the author in the aim section of the paper where it is mentioned that this review will found out whether doing advance care planning is beneficial for the patients or not. It would also help people know whether there is any change in the patient outcome or not. It is also mentioned that this review could offer a fresh perspective for informed healthcare practice. However, more attention could be paid on other benefits of the review such as it can help and influence people to make changes in the care delivery which is being provided to the patient so that enhancement of their health status could be done. The study can also help patients to know what they will be requiring for their future care and how they want to be treated (Silvester et al., 2013). Therefore, it can be said that potential advantages which are written in the review literature are proper and correct. However, more of them could also be stated so that more benefits could be known about the article and the study which is conducted.
In the review article, it is clearly outlined why this issue is important for healthcare practice. The author has mentioned that many people are moving towards their old age and with time they become frail and thus they have to face multi-morbidities and for that, they require palliative care for themselves. Therefore, they make use of advance care planning to attain the best outcome while they become old. With the help of advance care plan, people generally chose their own care for the time when their lives are about to end. Therefore, this issue is clearly focused. However, the author could also tell about disadvantages if this type of care is not implemented and what will be implications on the patients for example patients would not be ready for their future and would not be able to manage their condition which will ultimately lead to the low quality of life (Zwakman et al., 2018). By this, the requirement of the issue on the health care practice will be more accurately known. Therefore, it can be said that more information could be written in the paper about the significance of advance care planning in health care by also discussing its implication if it is not in the practice.
The author has mentioned about inclusion and exclusion criteria for the search. In the inclusion criteria, it is stated that articles are taken from the year 2015-2020 which shows that only current articles are chosen. However, the author could also put a filter for only full-text articles so that an article with just abstract or half information would not be included in the review. It was appropriate for the author to make use of Boolean operators such as AND and OR with the keywords which are identified. Representation of search terms in combination with Boolean operators was very good. In addition to that, correct and authentic databases were used for the retrieval of research articles such as PubMed, Medline, CINHAL and so on. The PRISMA flow chart was also accurate for showing how the articles were selected for the review and how they are eliminated in the process. Therefore, it can be said that the search strategy was quite good however more exclusion criteria could be included so that better results would be obtained.
The studies which are taken for review utilised different methods. For example, in the text, it is mentioned that 1 study was a randomised control trial and three were cohort studies. In addition to that, two were cross-sectional studies and two were mixed methods studies. The author could have taken more randomized control trial studies because they are at a higher level of the hierarchy of scientific evidence. With that, a randomized control trial is a method which is of the gold standard which helps to recognise the efficacy or safety of the practice or treatment. This kind of study also offers evidence for healthcare professionals to provide the best care to the patients (Goenka et al., 2019). Other than this, the tools which are used for critical evaluation and appraisal were appropriate as they were applied differently to qualitative and quantitative researches. However, the author could write which study used which method or design so that more clarity could be gained while reading the text. Therefore, it can be said that the critical appraisal method was very good as different tools were utilized but randomised control trial study could be more in number for the review.
In the summary table, the study of Konttila et al., (2020), was stated. In this article, the main focus was given to physician treatment option (PTO) and not on advance care planning by the individuals and it was also mentioned that it is not generalized for the people living in another country. Therefore, this study could be removed and another study could be taken for the review purpose (Konttila et al., 2020). Also, the research conducted by Martin et al., (2019), did not completely focus on advance care planning but on goals of patient care (GOPC) and also the findings were about GOPC and its benefit (Martin et al., 2019). In the study performed by Nakashima et al. (2017), the main point which is highlighted in do not hospitalise order from the patients but this does not offer any other information about advance care planning and their uses (Nakashima et al., 2017). Other than this, the research evidence was divided into significant themes for example adherence- why plans don't stick, doctors orders! Surrounding support for adherence care plans and plan or no plan! Point of care decision. The themes which were chosen were thus appropriate and it includes articles and their findings in it. Therefore, it can be said that research evidence was arranged in a logical manner. However, some articles could be replaced as they do not entirely discuss advance care planning.
The discussion was written by the author in whom statistics were mentioned about the older people and their deaths. It was also stated that advance care planning documentation is inconsistent and vague which could lead to a difference in opinions. However, they provide many orders from the patient that could be useful for the healthcare professionals and lower down the rates of hospitalization. The section of discussion only talks about the findings of other people but it does not highlight what the author has suggested after the review. The author should have made a point and then should state about the articles which are coherent with the findings of the review paper. The writer has only said that standardisation is needed so that better outcomes and results could be gained in the case of patients. Therefore, it can be said that the discussion part could be improvised in order to pay attention to the main finding of the review article. The evidence which is presented here is appropriate and thus states about this issue and its impact on the health of the people.
The summary section was missing from the review article. However, the author has presented the main findings of all the articles reviewed in the discussion section but the discussion section does not present the main idea properly. The findings of the review article are not clear. In addition to that, the author has not mentioned a clear outline starting from the introduction section until the end of the review. The writer has not summarised all the points of the article in chronological order thus it will take more time for readers to get the idea of what the article is about. If the author has provided a summary then all the main themes and ideas will be highlighted and it would have made reading more engaging for the reader. Therefore, it can be said that a proper summary should be added at the end so that the person who is reading the article could get the idea of what is happening in the paper.
The author has not identified research gaps properly as they should be written in a single section and not all over the review. The research gap which was recognised was that what will happen to the patient who has denied going to the hospital but then he had an infection or he falls down. This is a very big issue and thus it was good that it comes into the light. The author has vaguely stated that documents are not consistence. Hence, their standardization is required for better understanding. Therefore, it can be said that the writer could have mentioned all the research gaps in a separate section so that readers do not face difficulty in finding them. However, the gaps which are highlighted are good and proper and are incoherent with the issue raised in the review article.
A proper discussion was presented at the end of the article about implications for healthcare practise, education and future research. For the healthcare practice, the author has suggested that advance care planning should be utilised for taking care of patients by supporting their needs and requirements. In the education section, it is discussed that healthcare providers should be incorporated in advance care planning and people should know to use and interpret the document of advance care. And for research, it is stated that more findings are needed to be done so that outcomes could be known of patients who make use of advance care planning. Hence, this part is correct and relevant and it describes each section very nicely with respect to advance care planning.
Therefore, in the end, after reviewing the whole article, it can be said that the article is very nicely written. The search strategy and the appraisal strategy of founded articles were very much appropriate and relevant. However, the choice of reviewed articles could be made better and summary could also be included for a better understanding of the article. The structure of the review was very well-formed and also the writing was very good and clear for understanding purpose.
Goenka, L., Rajendran, S., Arumugam, K., Rani, J., & George, M. (2019). The assessment of the quality of randomized controlled trials published in Indian medical journals. Perspectives in Clinical Research, 10(2), 79–83. https://doi.org/10.4103/picr.PICR_60_18
Konttila, T., Finne-Soveri, U. H., Leskinen, R., Niemelä, K., & Antikainen, R. (2020). Progress in advance care planning among nursing home residents dying with advanced dementia-Does it makes any difference in end-of-life care?. Archives of Gerontology and Geriatrics, 86, 103955. https://doi.org/10.1016/j.archger.2019.103955
Martin, R. S., Hayes, B. J., Hutchinson, A., Tacey, M., Yates, P., & Lim, W. K. (2019). Introducing goals of patient care in residential aged care facilities to decrease hospitalization: A cluster randomized controlled trial. Journal of the American Medical Directors Association, 20(10), 1318-1324. https://doi.org/10.1016/j.jamda.2019.06.017
Nakashima, T., Young, Y., & Hsu, W. H. (2017). Are hospital/ED transfers less likely among nursing home residents with do-not-hospitalize orders?. Journal of the American Medical Directors Association, 18(5), 438–441. https://doi.org/10.1016/j.jamda.2016.12.004
Silvester, W., Parslow, R. A., Lewis, V. J., Fullam, R. S., Sjanta, R., Jackson, L., ... & Hudson, R. (2013). Development and evaluation of an aged care specific advance care plan. BMJ Supportive & Palliative Care, 3(2), 188-195. http://dx.doi.org/10.1136/bmjspcare-2012-000392
Zwakman, M., Jabbarian, L. J., van Delden, J., van der Heide, A., Korfage, I. J., Pollock, K., Rietjens, J., Seymour, J., & Kars, M. C. (2018). Advance care planning: A systematic review about experiences of patients with a life-threatening or life-limiting illness. Palliative Medicine, 32(8), 1305–1321. https://doi.org/10.1177/0269216318784474
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