Table 2. GRADE Summary of Findings Table—Secondary outcomes.
| Outcome | № of participants (studies) | Relative effect (95% CI) | Anticipated absolute effects in study population (95% CI) * | Quality & Justification for Ratings | ||
|---|---|---|---|---|---|---|
| Without Communication tools for end-of-life decision-making | With Communication tools for end-of-life decision-making | Difference | ||||
| Preference for life-sustaining treatments | № of participants: 877 (7 RCTs) | RR 0.62 (0.41 to 0.94) | 283 per 1000 | 170 per 1000 (112 to 247) | 113 fewer per 1000 (171 fewer to 36 fewer) | ●●●○ MODERATE 1 |
| Concordance of preferred advance directive between patient and substitute decision-maker | № of participants: 541 (6 RCTs) | - | The mean concordance of preferred advance directive between patient and substitute decision-maker was 0 | The mean concordance of preferred advance directive between patient and substitute decision-maker in the intervention group was 1.12 standard deviations more (0.62 more to 1.62 more) | SMD 1.12 more (0.62 more to 1.62 more) | ●●○○ LOW 2 3 |
| Quality of communication between patients and SDMs | № of participants: 126 (2 RCTs) | - | The mean congruence of preferred advance directive between patient and substitute decision-maker was 0 | The mean quality of communication between patient and SDM in the intervention group was 0.07 standard deviations more (0.28 less to 0.43 more) | SMD 0.07 more (0.28 less to 0.43 more) | ●○○○ VERY LOW 4 5 6 |
| Quality of communication between patients and HCPs | № of participants: 126 (2 RCTs) | - | The mean quality of communication between patients and HCP score was 7.65 | The mean quality of communication between patient and SDM in the intervention group was 3.02 standard deviations more (1.26 more to 4.78 more) | MD 3.02 more (1.26 more to 4.78 more) | ●○○○ VERY LOW 2 5 6 |
| Knowledge and literacy for end-of-life care practices | № of participants: 427 (4 RCTs) | - | The mean knowledge and literacy for end-of-life care practices was 0 | The mean knowledge and literacy for end-of-life care practices in the intervention group was 0.56 standard deviations more (0.26 more to 0.86 more) | SMD 0.56 more (0.26 more to 0.86 more) | ●●●○ MODERATE 2 6 |
| Knowlege and literacy of advance care planning | № of participants: 441 (4 RCTs) | - | The mean knowlege and literacy of advance care planning process was 0 | The mean knowlege and literacy of advance care planning process in the intervention group was 0.3 standard deviations more (0.12 more to 0.49 more) | SMD 0.3 more (0.12 more to 0.49 more) | ●●●○ MODERATE 2 6 |
| Satisfaction with end-of-life care | № of participants: 565 (5 RCTs) | - | The mean satisfaction with end-of-life care and care planning was 0 | The mean satisfaction with end-of-life care and care planning in the intervention group was 0.03 standard deviations lower (0.26 lower to 0.21 higher) | SMD 0.03 lower (0.26 lower to 0.21 higher) | ●○○○ VERY LOW 4 5 6 |
CI: Confidence interval; RR: Risk ratio; OR: Odds ratio. High quality: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect. Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.
* The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
1 Suspected publication bias based upon visual inspection of funnel plot.
2 Most information is from studies at 'uncertain' rather than 'low' risk of bias.
3 Large amount of statistical heterogeneity, but between large and small positive treatment effects rather than between positive and negative treatment effects.
4 Most information is from studies at high risk of bias.
5 Most information is from surrogate or variable outcomes rather than from objective and direct outcomes.
6 Insufficient sample to meet optimal information size criteria and 95% CI close to or crosses line of no effect.