Better goals-of-care documentation does not reliably mean better outcomes

A systematic narrative review of 41 clinical trials, conducted between 2010 and 2025 and predominantly from the United States (68% randomised controlled trials), examined interventions designed to improve goals-of-care conversations in serious illness. Patient-focused interventions increased patients’ readiness for these conversations and improved documentation, but showed mixed results on clinical outcomes. Clinician- and system-level interventions improved documentation and conversation quality, but had inconsistent effects on healthcare utilisation. Combined interventions improved communication overall, but not consistently quality of life or utilisation.

Synthesis As a narrative rather than a statistical meta-analysis, this review cannot supply a single pooled effect size, and it draws mainly on a US trial base whose service context differs from the NHS. Its consistent message across intervention types, however, is that documentation and conversation-quality gains — the outcomes most often reported and celebrated when advance care planning initiatives are evaluated — do not reliably translate into the outcomes that matter most to patients and services: fewer unwanted hospital admissions, or a better quality of life.

For services evaluating their own goals-of-care or advance care planning work, this is a caution against treating a rising rate of documented conversations as, by itself, evidence of improved outcomes. Whether a plan travelled with the patient and changed what happened to them is a different, and necessary, measure.