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. Author manuscript; available in PMC: 2024 Jun 1.
Published in final edited form as: J Pain Symptom Manage. 2023 Feb 9;65(6):e715–e743. doi: 10.1016/j.jpainsymman.2023.02.003

Table 1.

Study and Sample Characteristics

Author
(Year)		 Country Design ACP Typea Outcomes Analyzed
Sample
(n)		 Mean
Age
(years)		 Males (%) Racial/
Ethnic
Minority
(%)		 Cancer
Inclusion
Criteria
Ahluwalia(61) (2015) United States Observational: retrospective chart review Communication: prognosis and end-of-life preferences Use of Aggressive Care:

  • Acute care (i.e., ED visit, hospital admission, hospital death)

  • Chemotherapy

  • Hospice use fewer than 3 days

  • Intensive interventions (i.e., ICU admission, mechanical ventilation)

 665 66.4 97.1 25.3 Terminal cancer indicators
Cagle(51) (2020) United States Observational: secondary analysis of a national dataset of a prospective cohort Documents: advance directive Comfort-focused Care:

  • Hospice use

 271 76.2 59.4 25b Cancer-related death cases
Chen(62) (2019)/Wen(63) (2020) Taiwan Experimental: RCT of an ACP intervention Communication: prognosis and end-of-life preferences Use of Aggressive Care:

  • CPR

  • ICU care

  • Mechanical ventilation

 430 missc 70.4 miss Terminal cancer indicators
Dalmau-Bueno(64) (2021)d Spain Observational: case control study Documents: advance directive Use of Aggressive Care:

  • Artificial Nutrition

  • CPR

  • Dialysis

  • ED admission

  • Mechanical ventilation

  • Surgery

 2,338 missc 48.7 miss Cancer-related death cases
Diamond(65) (2016) United States Observational: retrospective cohort study Documents: healthcare surrogate designation Use of Aggressive Care:

  • Hospice fewer than 7 days

 160 63.4 58 38 Diagnosis-specific
Halpern(66) (2011) United States Observational: retrospective chart review Documents: living will or healthcare surrogate designation Use of Aggressive Care:

  • CPR

Comfort-focused Care:

  • DNR

  • No escalation of care

  • Withdrawal of life-sustaining treatment

 1,121 61.5 60 21.2 Diagnosis-specific
Ishikawa(67) (2018) Japan Observational: retrospective chart review Communication: prognosis Use of Aggressive Care:

  • Hospital death

 107 77 46.7 miss Terminal cancer indicators
Jeurkar(68) (2012)d United States Observational: retrospective chart review Documents: advance directive Comfort-focused Care:

  • Home death

 3,561 72.6 50.9 10.9 Terminal cancer indicators
Johnson(8) (2018)d Australia Experimental: RCT of an ACP intervention Full ACP Use of Aggressive Care:

  • Chemotherapy

  • Hospital death

 150 65.5 53.4 miss Terminal cancer indicators
Mack(50) (2012) United States Observational: secondary analysis of a cancer registry database Communication: end-of-life preferences Use of Aggressive Care:

  • Acute care (i.e., ED or hospital admission)

  • Aggressive care (i.e., any acute or ICU care)

  • Chemotherapy

  • Hospice use fewer than 7 days

  • ICU care

Comfort-focused Care:

  • Hospice use

 1,231 missc 62 24 Terminal cancer indicators
McDermott(69) (2020) United States Observational: retrospective cohort study Documents:e healthcare surrogate designation and/or living will Use of Aggressive Care:

  • ED admission

  • Hospital admission

  • Hospital death

  • ICU admission

 15,092 64.5 56.7 14.6 Terminal cancer indicators
Narang(45) (2015) United States Observational: secondary analysis of a national dataset of a prospective cohort Documents:f living will Use of Aggressive Care:

  • Aggressive care composite (i.e., “all care possible” given)

  • Hospital death

Comfort-focused Care:

  • Treatments limited or withheld

 1,985 missc 54 13.7b Cancer-related death cases
Peltier(47) (2017) United States Experimental: evaluation of an ACP-centered program Full ACP Use of Aggressive Care:

  • Chemotherapy

  • ED admission

  • Hospital admission

  • ICU admission

Comfort-focused Care:

  • DNR

  • Hospice use

 69 miss 52.2 28 Cancer-related death cases
Prater(70) (2019) United States Observational: retrospective chart review Communication: end-of-life preferences Use of Aggressive Care:

  • Hospital admission

 1,185 63.7 51.6 12.9 Terminal cancer indicators
Prater(71) (2022) United States Observational: retrospective medical claims analysis Communication: ACP encounter (via billing code) Use of Aggressive Care:

  • Hospital admission

 3,705 56.2 40.4 miss Terminal cancer indicators
Rocque(46) (2017) United States Experimental: evaluation of an ACP-centered program Full ACP Use of Aggressive Care:

  • Chemotherapy

  • ED admission

  • Hospice fewer than 3 days

  • Hospital admission

  • ICU use

Comfort:

  • Hospice use

 608 76.4 53.8 19 Terminal cancer indicators
Salazar(72) (2022) United States Observational: retrospective chart review Documents: advance directive Use of Aggressive Care:

  • Chemotherapy

  • Hospital admission

  • ICU admission

  • Intensive interventions composite (i.e., hemodialysis, mechanical ventilation, CPR)

  • Any aggressive care

 113 missc 58 20 Cancer-related death cases
Sedhom(73) (2021) United States Observational: retrospective chart review Communication: prognosis and goals-of-care Use of Aggressive Care:

  • Hospice use fewer than 3 days

 147 missc 51.7 19.7b Diagnosis-specific
Wallace(74) (2001) United States Observational: retrospective chart review Documents: advance directive Use of Aggressive Care:

  • CPR

  • Mechanical ventilation

Comfort-focused Care:

  • DNR

 270 55 56.7 miss Diagnosis-specific
Wright(49) (2008) United States Observational: retrospective cohort study Communication: end-of-life preferences Use of Aggressive Care:

  • Chemotherapy

  • CPR

  • Hospice use fewer than 7 days

  • ICU admission

  • Mechanical ventilation

Comfort-focused Care:

  • Hospice use

 332 57.9 55.1 36 Terminal cancer indicators
a

Documents (living will only, healthcare surrogate only, or both—synonymous with an advance directive), Communication (end-of-life preferences, prognosis, or goals of care), 3) Full ACP (all three components), or 4) unspecified ACP

b

Hispanic ethnicity reported as a separate variable, and thus, was not reflected in the proportion of minorities

c

Mean age data not reported, instead median or age ranges described

d

Studies where cancer death cases comprised a subset of the full sample, but demographics were only reported for the full sample

e

Study conceptualization of ACP included a range of ACP behaviors, inclusive of physician orders for life-sustaining treatment (POLST), however, the proportion of ACP that was POLST was not specified

f

Outcomes associated with healthcare surrogate designation and communication were also reported; however, there was participant crossover between ACP types, so only one type was utilized for the analysis

Abbreviations: ACP is advance care planning, AML is acute myeloid leukemia, CPR is cardiopulmonary resuscitation, DNR is do-not-resuscitate, ED is emergency department, ICU is intensive care unit, miss is missing,

Note: Terminal cancer indicators included patients with advanced stage and/or metastatic disease, progressive disease, disease unresponsive to treatment, or patients who were hospice eligible