The Role of Advance Care Planning in Hospital Transfer From Aged Care Facilities at the End-of-Life: A Scoping Review.

Approximately 70% of aged care residents are transferred to a hospital during the last few months of life. Many factors contribute to hospital transfer at the end-of-life; however, little is known about the role of advance care planning on hospital transfer decision-making. A scoping review using Arksey and O'Malley's framework and the Joanna Briggs Institute Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews was conducted to reveal the available research on hospital transfers of aged care residents at the end-of-life and the role of advance care planning. Seven databases were searched. One hundred and ninety-seven potential papers were identified from screening. After applying the population concept context inclusion and exclusion criteria, 23 research papers were identified; most were quantitative (n = 15), n = 7 were qualitative, and 1 was mixed methods. Studies were from 9 different countries and published between 2004 and 2024. Advance care plans or advance care directives that included instructions to not resuscitate or not hospitalize resulted in fewer hospital transfers than those that did not. Reasons for hospital transfer were classified as age, acuity, vulnerability, and family-related. Of concern were reports of hospital transfers against resident's wishes as documented on advance care plans and advance care directives.