Enhancing goals of care discussions: a systematic review and meta-analysis of clinician-directed behavioural nudges.
Background Goals of care discussions (GOCDs) are critical for patients with serious illnesses but are hindered by clinician-level barriers. Nudges—low-burden, behaviourally informed strategies that influence clinician behaviour without restricting choice—may provide a scalable approach to increase G...
| Publicado en: | Age & Ageing Vol. 55; no. 4; pp. 1 - 10 |
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| Autores principales: | , , |
| Formato: | Artículo |
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Oxford University Press / USA
Apr2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=193500106&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 193500106 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00020729 AGA jtl: Age & Ageing issn: 00020729 maglogo: N pubinfo: dt: Apr2026 vid: 55 iid: 4 pid: 622 pub: Oxford University Press / USA artinfo: ui: 193500106 10.1093/ageing/afag113 ppf: 1 ppct: 9 formats: tig: atl: Enhancing goals of care discussions: a systematic review and meta-analysis of clinician-directed behavioural nudges. aug: au: Poco, Louisa Shah, Shimoni Malhotra, Chetna affil: Duke-NUS Medical School, Singapore Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Singapore 169547, Singapore Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore 169547, Singapore su: Documentation Palliative treatment Medical quality control Hospital care Decision making Evaluation of medical care Physician-patient relations Communication Advance directives (Medical care) Education of physicians Psychology of physicians Medical care use Medical information storage & retrieval systems Research funding Patient readmissions Meta-analysis Descriptive statistics Systematic reviews MEDLINE Odds ratio Intensive care units Conceptual structures Length of stay in hospitals Confidence intervals Quality assurance Online information services Data analysis software Medical referrals sug: subj: Documentation Palliative treatment Medical quality control Hospital care Decision making Evaluation of medical care Physician-patient relations Communication Advance directives (Medical care) Offices of physicians Offices of Physicians (except Mental Health Specialists) Education of physicians Psychology of physicians Medical care use Medical information storage & retrieval systems Research funding Patient readmissions Meta-analysis Descriptive statistics Systematic reviews MEDLINE Odds ratio Intensive care units Conceptual structures Length of stay in hospitals Confidence intervals Quality assurance Online information services Data analysis software Medical referrals keyword: advance care planning behavioural interventions care goals copyrightHolder:British Geriatrics Society copyrightYear:2026 end-of-life-care https://dx.doi.org/10.1093/ageing/afag113 inLanguage:en nudges older people publisher:Oxford University Press sameAs:https://pubmed.ncbi.nlm.nih.gov/42051142/ systematic review advance care planning behavioural interventions care goals copyrightHolder:British Geriatrics Society copyrightYear:2026 end-of-life-care https://dx.doi.org/10.1093/ageing/afag113 inLanguage:en nudges older people publisher:Oxford University Press sameAs:https://pubmed.ncbi.nlm.nih.gov/42051142/ systematic review ab: Background Goals of care discussions (GOCDs) are critical for patients with serious illnesses but are hindered by clinician-level barriers. Nudges—low-burden, behaviourally informed strategies that influence clinician behaviour without restricting choice—may provide a scalable approach to increase GOCDs. We systematically reviewed and meta-analysed the effect of clinician-directed nudges on GOCD documentation. Secondary outcomes were quality of communication and healthcare utilisation. Methods We searched three databases (2004–2024). Nudges were classified using the MINDSPACE framework. Random-effects meta-analysis estimated pooled odds ratios (ORs) with 95% confidence intervals (CIs) for GOCD documentation. Subgroup analyses examined nudge type, study design and co-interventions. Secondary outcomes were narratively synthesised. Results Fifty-one studies were included (16 randomised trials, 7 non-randomised controlled studies and 28 pre-post studies). Salience-based nudges, which make key information more noticeable, were most common (86% of interventions). Most interventions (87%) were multicomponent. Nudges increased GOCD documentation (OR 3.30, 95% CI 2.40–4.53). Multicomponent interventions with a nudge component had larger effects than nudges alone (OR 4.03 vs. 1.89; P = .03). No differences were observed by nudge types or study designs. Heterogeneity was high (I = 96.7%) but leave-one-out sensitivity analyses supported robustness. Nudges improved quality of communication (2/2 studies) and reduced readmissions (2/2), with inconsistent effects on palliative care referrals (5/19) and no impact on hospital length of stay (0/5). Conclusion Clinician-directed nudges improve GOCD documentation and represent a scalable, low-cost strategy for quality improvement. Future research should examine a broader range of nudges, multilevel interventions and effects on the quality and timing of GOCDs across settings. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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