BMC Palliat Care. 2026 Jun 6. doi: 10.1186/s12904-026-02184-z. Online ahead of print.
ABSTRACT
BACKGROUND: Advance care planning (ACP) is important in cancer care, but discussions are often delayed or inconsistently implemented. Online ACP decision aid programmes may support ACP participation, although their effects in adults with cancer remain unclear.
METHODS: A systematic search of MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, the Cochrane Library, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, and supplementary sources was conducted from inception to 10 March 2026. Quantitative studies evaluating online ACP decision aid programmes for adults with cancer were included. Risk of bias was assessed using appropriate tools according to study design. Meta-analyses were performed using fixed- or random-effects models.
RESULTS: Twelve studies met the eligibility criteria, including 10 randomised controlled trials, 1 pre-post study, and 1 single-arm quantitative evaluation study. Most studies were conducted in the USA. Pooled evidence showed that online ACP decision aid programmes significantly improved ACP documentation (OR = 2.06, 95% CI 1.29 to 3.27, p = 0.002) and ACP engagement (MD = 0.28, 95% CI 0.15 to 0.40, p < 0.0001). No statistically significant effects were found for AD completion (OR = 1.37, 95% CI 0.54 to 3.45, p = 0.50), satisfaction (MD = 0.15, 95% CI -0.25 to 0.55, p = 0.47), decisional conflict (MD=-0.72, 95% CI -5.87 to 4.43, p = 0.78), or anxiety (MD=-0.76, 95% CI -1.67 to 0.16, p = 0.11). Sensitivity analyses suggested that the findings for ACP documentation and ACP engagement were relatively robust, whereas the results for satisfaction and anxiety were less stable.
CONCLUSIONS: Online ACP decision aid programmes may support ACP in adults with cancer, particularly by improving ACP engagement and ACP documentation. However, evidence for benefits beyond ACP process outcomes remains limited or inconsistent. Further rigorous studies are needed to identify effective programme features and implementation strategies.
PMID:42251411 | DOI:10.1186/s12904-026-02184-z
