ORIGINAL RESEARCH article
Front. Med.
Sec. Family Medicine and Primary Care
This article is part of the Research TopicDigital Health Innovations for Patient-Centered CareView all 44 articles
Effectiveness of Digital Tools in Promoting Advance Care Planning: A Systematic Review Protocol
Provisionally accepted
- 1Alexandra Hospital, Singapore, Singapore
- 2University of Bristol School of Civil Aerospace and Mechanical Engineering, Bristol, United Kingdom
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Background: Despite compelling evidence supporting advance care planning (ACP) benefits in improving end-of-life care quality and patient autonomy, ACP completion rates remain suboptimal globally, with only 20-40% of adults in developed countries having completed any form of advance directive. Digital health technologies offer promising solutions to overcome traditional barriers to ACP engagement. While numerous studies have evaluated individual digital ACP interventions, the evidence base remains fragmented and heterogeneous, with existing reviews often focusing on specific populations, settings, or technologies, limiting generalizability. This systematic review aims to comprehensively evaluate the effectiveness of digital tools and interventions in promoting advance care planning engagement, completion, and quality across diverse populations and healthcare settings, and identify successful intervention components and implementation strategies. Methods: This systematic literature review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of eight databases will be conducted from inception to July 2025, along with grey literature sources. The review will include randomized controlled trials, quasi-experimental studies, and observational studies evaluating digital health interventions for ACP in adults aged ≥18 years. The PICOS framework will guide study selection, with interventions including web-based platforms, mobile applications, video-based decision aids, telehealth platforms, and emerging technologies. Primary outcomes include ACP engagement rates, advance directive completion, and quality of ACP discussions. Two independent reviewers will conduct study screening, data extraction, and quality appraisal using the Cochrane Risk of Bias tool 2.0 (RoB 2) for randomized trials and ROBINS-I for non-randomized studies. Both narrative synthesis and meta-analysis will be employed where appropriate. Discussion: This protocol outlines a comprehensive systematic review utilizing rigorous methodology to synthesize evidence on digital tools for advance care planning. The findings will provide valuable insights into the effectiveness of various digital ACP interventions, identify optimal intervention components, and highlight implementation considerations. Results will inform healthcare providers, policymakers, and technology developers in implementing evidence-based digital ACP interventions while identifying research gaps requiring future investigation. Trial registration: PROSPERO: CRD420251108596.
Keywords: Advance Care Planning, Digital Health, End-of-life care, healthcare technology, implementation research, patient engagement
Received: 04 Sep 2025; Accepted: 02 Dec 2025.
Copyright: © 2025 Shankar, Devi and Xu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ravi Shankar
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.