Effectiveness of Digital Tools in Promoting Advance Care Planning: A Systematic Review Protocol
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Background
Despite compelling evidence supporting advance care planning (ACP) benefits in improving end-of-life care quality and patient autonomy, ACP completion rates remain suboptimal globally, with only 20-40% of adults in developed countries having completed any form of advance directive. Digital health technologies offer promising solutions to overcome traditional barriers to ACP engagement, including accessibility, scalability, and cost-effectiveness challenges. While numerous studies have evaluated individual digital ACP interventions, the evidence base remains fragmented and heterogeneous, with existing reviews often focusing on specific populations, settings, or technologies, limiting generalizability. This systematic review aims to comprehensively evaluate the effectiveness of digital tools and interventions in promoting advance care planning engagement, completion, and quality across diverse populations and healthcare settings, and identify successful intervention components and implementation strategies.
Methods
This systematic literature review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of eight databases (PubMed, Web of Science, Embase, CINAHL, MEDLINE, The Cochrane Library, PsycINFO, and Scopus) will be conducted from inception to July 2025, along with grey literature sources. The review will include randomized controlled trials, quasi-experimental studies, and observational studies evaluating digital health interventions for ACP in adults aged ≥18 years. The PICOS framework will guide study selection, with interventions including web-based platforms, mobile applications, video-based decision aids, telehealth platforms, and emerging technologies. Primary outcomes include ACP engagement rates, advance directive completion, and quality of ACP discussions. Two independent reviewers will conduct study screening, data extraction using Covidence software, and quality appraisal using the Cochrane Risk of Bias tool 2.0 (RoB 2) for randomized trials and ROBINS-I for non-randomized studies. Both narrative synthesis and meta-analysis will be employed where appropriate.
Discussion
This protocol outlines a comprehensive systematic review utilizing rigorous methodology to synthesize evidence on digital tools for advance care planning. The findings will provide valuable insights into the effectiveness of various digital ACP interventions, identify optimal intervention components, and highlight implementation considerations. Results will inform healthcare providers, policymakers, and technology developers in implementing evidence-based digital ACP interventions while identifying research gaps requiring future investigation. The review will contribute to ensuring that all individuals have access to effective, culturally appropriate tools that empower them to engage in advance care planning according to their values and preferences.
