Scoping review catalogues 27 interventions to improve advance care planning among structurally vulnerable populations

A scoping review of 70 studies published between January 2003 and October 2024 examined advance care planning (ACP) among people experiencing structural vulnerability — housing instability, poverty, racialised identity (Black or Indigenous populations in the reviewed literature), serious mental illness, or substance use disorders Synthesis. The review identified 13 recurring barriers, 13 facilitators and 27 distinct interventions.

The most common barriers were low ACP literacy, discomfort with conversations about mortality, personal, cultural or spiritual beliefs, and familial and social isolation; the most common facilitators were trusted provider relationships, provider training and empowerment, social support, and tailored ACP content and delivery. The authors found these barriers and facilitators were commonly shared across different structurally vulnerable populations, rather than being specific to any one group. The 27 catalogued interventions most often involved ACP education and outreach, or guided ACP conversations, and the authors judge these approaches show the most promise where providers are able to incorporate the identified facilitators.

As a scoping review, this maps and catalogues the existing evidence base rather than testing a specific intervention’s effectiveness against a control; the authors do not rank the 27 interventions by strength of evidence.

For services seeking to close known equity gaps in ACP completion among deprived or otherwise structurally vulnerable populations, this offers a practical starting catalogue of interventions with a shared evidence base across multiple vulnerable groups, rather than requiring a bespoke evidence search for each population separately.