Systematic review sets out what makes advance care planning work in nursing homes

A PROSPERO-registered systematic review in the Journal of Palliative Medicine drew on 19 studies to identify the structural and process determinants of advance care planning (ACP) implementation quality in nursing homes, using Donabedian’s structure-process-outcome model of quality of care [Synthesis]. It found implementation quality depends on regulatory integration, role clarity among staff, dedicated time and training, resident and family engagement, and standardised documentation.

Rather than testing a single intervention, the review synthesises what distinguishes nursing homes that implement ACP well from those that do not — a determinants framework rather than a single practice-changing recommendation. The authors do not report which determinant matters most, or whether they act independently of one another.

For care-home commissioning and regulation, this offers a structured checklist against which to audit existing ACP implementation in nursing homes — protected staff time and training, documented role clarity, and family engagement processes — rather than assuming that policy commitment to ACP alone will translate into practice.