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65/100

✓ Peer-reviewed alzhub usefulness score 65 out of 100. Disparities

Topic: Risk, prevention and care in population studies

Plain-language summary

Background Planning ahead may be particularly relevant in dementia considering patients' cognitive decline and difficulty to predict the course of the dementia. Objective To identify factors associated with initiation of advance care planning (ACP) regarding end-of-life issues in dementia. Methods Systematic review of the PubMed, Embase, Cinahl, Psychinfo, and Cochrane databases until January 2013. We included articles reporting on empirical research, identifying factors related to initiation of ACP defined as starting a discussion, starting the decision making, or having a documented patient-written advance directive. Results Of 4,647 unique articles, we assessed 178 as full-texts, and included 33. Most designs (64%) were qualitative; 42% limited to moderate to severe, and 6% to mild to moderate stages. Perspectives varied: family (33%), professional caregivers (24%), patient (15%), or multiple (27%). A variety of factors with complex interplay was involved in initiating ACP. Family factors dominated, with family's initiative or lack of it, and willingness or reluctance to engage in initiating ACP identified in a series of studies. Further, professional caregivers' initiative or lack of it and patient's health status were important factors that facilitated or hindered initiating ACP. Ethnic minority status of those involved and family distance may be barriers. Continuity of care and health care system factors also affected initiating of ACP. Conclusion Professional caregivers may initiate ACP early if strategies carefully consider timing and family and patient receptiveness or reluctance, and are family and patient-centered. Interventions should address the complexity of interrelated system and personal factors affecting initiation of ACP.

What this study adds

Evidence grade: High

This is a pooled review of 33 participants. This systematic review identified factors associated with starting advance care planning in dementia, with family factors dominating and ethnic minority status and family distance acting as possible barriers. It concerns end-of-life planning rather than treating, curing or preventing Alzheimer's disease.

Taken from this record’s own fields, not from reading the paper. The grade is assigned from the abstract’s wording; what that means.

Cite this study APA, Vancouver, BibTeX · download .bib or .ris

APA 7th

van der Steen, J. T., van Soest-Poortvliet, M. C., Hallie-Heierman, M., Onwuteaka-Philipsen, B. D., Deliens, L., de Boer, M. E., et al. (2014). Factors associated with initiation of advance care planning in dementia: a systematic review. Journal of Alzheimer's disease : JAD. https://doi.org/10.3233/jad-131967

Vancouver

van der Steen JT, van Soest-Poortvliet MC, Hallie-Heierman M, Onwuteaka-Philipsen BD, Deliens L, de Boer ME, et al. Factors associated with initiation of advance care planning in dementia: a systematic review. Journal of Alzheimer's disease : JAD. 2014. doi:10.3233/jad-131967. PMID: 24531163.

BibTeX

@article{vandersteen2014-24531163,
  author  = {van der Steen, J. T. and van Soest-Poortvliet, M. C. and Hallie-Heierman, M. and Onwuteaka-Philipsen, B. D. and Deliens, L. and de Boer, M. E. and Van den Block, L. and van Uden, N. and others},
  title   = {{Factors associated with initiation of advance care planning in dementia: a systematic review}},
  journal = {Journal of Alzheimer's disease : JAD},
  year    = {2014},
  doi     = {10.3233/jad-131967},
  pmid    = {24531163},
  url     = {https://doi.org/10.3233/jad-131967}
}

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How to read this study

Design: this is a pooled review. It combines earlier studies, so it is only as good as the studies it pools. Check how many were included, whether they were similar enough to combine, and whether the authors report inconsistency between them.
Size: the record lists 33 participants. Ask whether that is enough for the question, and who they were.
Effect: the record gives no effect size, so the summary above cannot say how large any difference was.

What the evidence grade means here

This page is graded high. alzhub.org assigns the grade automatically from keywords in the abstract, not from reading the paper. High means the abstract mentions a randomized design, a meta-analysis or a systematic review. It can add at most 5 of the 100 points in the study score, and it is a label about design, not a verdict on whether the findings are true.

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Key findings

Objective To identify factors associated with initiation of advance care planning (ACP) regarding end-of-life issues in dementia.
Results Of 4,647 unique articles, we assessed 178 as full-texts, and included 33.

Why it matters

This systematic review identified factors associated with starting advance care planning in dementia, with family factors dominating and ethnic minority status and family distance acting as possible barriers. It concerns end-of-life planning rather than treating, curing or preventing Alzheimer's disease.

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Study details

Study designsystematic review
Participants33
Evidence strengthHigh

How this study scored 65/100

Published in a peer-reviewed journal, and it is a systematic review of all the studies on the question. Scored zero for effect reported because the record does not state it.

Component	Points	Why
Journal tier	7 / 10	Tier 3 — peer-reviewed journal (Journal of Alzheimer's disease : JAD)
Journal's citation record	2 / 4	Journal of Alzheimer s Disease: journal h-index 218 (OpenAlex, 2026-10-29)
Study design	12 / 12	A systematic review of all the studies on the question
Strength of evidence	5 / 5	Rated “high” in our summary
Peer-review validation	10 / 10	Peer-reviewed. Published as an article in a named peer-reviewed journal.
How recent	1 / 5	2014 — within 20 year(s) of the newest study here
Sample size	1 / 4	33 participants
Effect reported	0 / 3	No effect size reported — scores zero (not stated in the record — scored 0)
Studied in people	3 / 3	Studied in people (participant count stated)
Randomized / blinded	0 / 2	A review of other studies — randomization is not credited here
Times cited	5 / 7	Cited 204 times (OpenAlex, 2026-10-10)
Citations per year	3 / 5	14.6 citations a year over 14 year(s) since 2014
Impact for its field and year	2 / 6	Cited 2.4× the average for papers of its field and year (OpenAlex FWCI)
Cited by studies here	3 / 6	Cited by 11 other studies in this library
Still being cited	2 / 4	Cited 36 times in 2024–2026 (2026 still in progress; OpenAlex)
Senior author's track record	4 / 4	Last-listed author Henrica C. W. de Vet: h-index 132 (OpenAlex, whole career)
Institution's track record	1 / 3	Ghent University: institution h-index 1,033 (OpenAlex)
Multicenter collaboration	2 / 3	OpenAlex lists 4 institution(s) in 2 countries
Indexed in PubMed	2 / 2	Indexed in PubMed (PMID 24531163)
Free to read	0 / 2	Behind a paywall — scores zero
Total	65 / 100	—

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