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Table 2 Summary of reviews focused on approaches to improve communication

From: Patient and service-related barriers and facitators to the acceptance and use of interventions to promote communication in health and social care: a realist review

Author & year Focus of review Number of studies included or type of study Summary of key findings
et al. (2009) [36]
Cochrane review: examined advance statement leads to less hospitalisation (either voluntary or involuntary).
People with mental illness
Advanced directives
Search strategy described
Inclusion criteria:
The review located 2 trials of n = 321 patients
Findings: Limited evidence to make definitive recommendations. More intensive forms of advance directives show promise, but currently practice must be guided by evidence other than that derived from RCTs. More trials are indicated to determine whether higher intensity interventions, such as joint crisis planning, have an effect on outcomes of clinical relevance.
Gysels, et al. (2006) UK Review: patient-held record
(PHR) in cancer care
People with cancer
Patient held records (PHR)
Systematic Review
Seven RCTs and six non-experimental studies were identified.
• randomized trials found an absence of effect
• non-experimental evaluations shed light on the conditions for its successful use. Most patients welcomed the introduction of a PHR. Main problems related to its suitability for different patient groups and the lack of agreement between patients and health professionals regarding its function.
• Further research is required to determine the conditions under which the PHR can realise its potential as a tool to promote continuity of care and patient participation.
Hayhoe, et al. (2011) UK [37] Narrative Review of Advance Care Planning (ACP) based on a narrative review of the literature
Not specified
Advance Care Planning (ACP)
Narrative review (no inclusion/exclusion criteria)
PubMed was searched using the terms ‘advance care
planning’, ‘living wills’, ‘advance decisions’.
Findings: ACP is supported by both patients and doctors and has documented benefits in extending autonomy and facilitating decision-making. Though currently under-used, partly through widespread lack of knowledge, it could be a valuable asset in end of life care if routinely discussed with patients.
May be relevant for older people, at greater risk of conditions affecting their capacity to make decisions. Problems include the anticipation of potential future clinical scenarios, the complex assessment of capacity to participate, and concerns about coercion. Additionally, ACP create a sense of urgency in ensuring that discussions take place while patients still retain capacity.
Continued low uptake of ACP suggests that further education of both public and health-care professionals need to take place regarding the benefits of ACP.
Kawi (2012) Review USA [38] Concept analysis of self-management support (SMS) to provide clarity for systematic implementation in practice.
Chronic conditions
Intervention/approach Self-management support (SMS)
Concept analysis – narrative review
No inclusion/exclusion criteria
Rodgers’ evolutionary concept analysis method was used. Data sources included systematic multidisciplinary
Background: SMS refers to comprehensive sustaining approaches toward improving chronic illness outcomes consisting of patient-centred attributes (involving patients as partners; providing diverse, innovative educational modalities specific to patients’ needs; individualizing patient care), provider attributes (possessing adequate knowledge, skills, attitudes in providing care), and organizational attributes (putting an organized system of care in place, having multidisciplinary team approach, using tangible and social support). SMS is a concept in its early phase of development. It is increasingly evident in literature on chronic illness care. However, the definition has been simplified or vague leading to variable SMS programs and inconsistent outcomes. Elucidation of SMS is necessary in chronic illness care to facilitate clear understanding and implementation.
   searches of multiple search engines. Implications: A well-clarified SMS concept is important in theory development. The attributes offer necessary components in SMS programs for systematic implementation, evaluation, and research.
There is great potential that SMS can help improve outcomes of chronic illness care.
Ko et al. (2010) Australia [39] Review: patient-held medical record (PHR), compared to usual care, improves clinical care, patient outcomes or satisfaction.
Chronic conditions
Patient Held Records (PHR)
14 studies, explored the use of PHR in diabetes, oncology, mental health, rheumatoid arthritis, stroke and palliative care. Findings: The studies used a variety of designs of PHR and compared this with usual care. PHR were implemented with varying degrees of patient and staff support and education, mainly for six months or less. Outcomes included attitudes on the usefulness of PHR, the quality of information exchange, process indicators, and clinical and physiological indicators.
The evidence on the effectiveness of PHRs is generally of low or very low quality.
These studies do not demonstrate a significant benefit of introducing PHR.
Conclusions: There is no clear benefit of implementing a PHR, and due to medium to high risk of bias these findings should be interpreted with caution. More high-quality studies are needed to evaluate properly the effectiveness of PHRs in chronic disease populations.
McCorkle et al. (2011) USA [40] Review: self-management interventions.
Patients with cancer
Intervention/approach Self-management
RCTs (n = 32) of self-
management interventions.
Findings: Self-management is poorly defined and a common set of self-management actions for cancer care notwithstanding, oncology practices can now build strong relationships with their patients and formulate mutually agreed upon care plans that enable and empower patients to care for themselves in the way they prefer.
Murphy et al. (2016) Ireland Cochrane Review: improving
palliative care delivered to people with advanced dementia
Patients with advanced dementia
Interventions aimed at improving palliative care
Cochrane Review
Extensive searches and
inclusion criteria described
2 studies located both from the USA
Findings: This review focused on interventions aimed to impact one or more of the following domains:
• The PLWD focusing on managing pain or on psychological, social, or spiritual dimensions of the patient
• The family/carer, with an emphasis on carer well-being, carer burden and grief or bereavement support
• The quality of care, which may include interventions such as advance care planning, staff education programmes or the organisation and delivery of care.
Conclusions: Giving relatives this information made it a little easier for relatives to make decisions about what methods would be used to feed the person with dementia.
Very little high-quality work has been completed exploring palliative care interventions in advanced dementia
Nicaise, et al. (2013) [41] Realist systematic review of
Psychiatric Advance Directives
(PADs); (e.g. Treatment preferences during crisis)
People with severe and chronic mental illness
Psychiatric advance directives
Forty-seven studies were retrieved, ranging from 1996 to 2009. emergency care, or reduction in the resort to coercion. The shape of the whole intervention at each stage relies on such clarification. More research is needed, particularly on the later stages of the intervention, as the evidence for how PADs should be implemented is still incomplete.
Reilly et al. (2015) Cochrane Review UK [42] Cochrane Review: case management approaches to home support for people with dementia.
Case management
13 RCTs involving 9615 participants with dementia in the review. Findings: Some studies examined the benefit of case management in reducing admissions to residential or nursing homes (institutionalisation). They found benefits at six months and 18 months but not at 12 and 24 months. Case management increases the use of community services but there was some indication that overall healthcare costs may be reduced in the first year. Some studies reported that case management was no more effective than usual care in improving patient depression, functional abilities or cognition.
There was not enough evidence to clearly assess whether case management could increase the length of time until people with dementia were admitted to care homes.