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This systematic review identifies key elements for successful ACP implementation, using PRISMA and Donabedian’s quality-of-care model. Searches in four databases (CINAHL, PsycInfo, SocINDEX, Medline Ovid) through June 2024 retrieved 2,013 studies; 19 met inclusion criteria after independent validation. Thematic analysis produced two major themes with 11 subthemes covering facility structural support and standardized implementation processes. Findings support future NH ACP quality improvement frameworks.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":40,"@type":76,"position":81},"https://docshare.wps.com/document/research-report/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/elements-for-successful-advance-care-planning-implementation-in-nursing-homes-a-systematic-review/427809/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/elements-for-successful-advance-care-planning-implementation-in-nursing-homes-a-systematic-review/427809.png","ImageObject",300,407,{"name":92,"@type":93},"Alex Sinclair","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-22","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":24},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why is advance care planning (ACP) important for nursing homes?","Question",{"text":112,"@type":113},"ACP improves the quality of end-of-life care. In nursing homes, its benefits are especially relevant because many residents spend their last days there.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was this systematic review conducted?",{"text":117,"@type":113},"The review followed PRISMA guidelines and searched four databases (CINAHL, PsycInfo, SocINDEX, Medline Ovid) in June 2024. From 2,013 studies, 19 were included after independent review and consensus.",{"name":119,"@type":110,"acceptedAnswer":120},"What key elements support successful ACP implementation in nursing homes?",{"text":121,"@type":113},"The review found two major themes: (1) nursing home structural support (policies, role clarity, and resources such as dedicated time and training) and (2) standardized implementation processes emphasizing engagement, trust building, documented discussions, interdisciplinary information sharing, and regular review.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},427809,1790875939,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":39,"category_name":40,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":24,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":24},1099523882182,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","768 Innovation in Aging, 2025, Vol. 9, No. S2  \nAbstract citation ID: igaf122.2611  \nELEMENTS FOR SUCCESSFUL ADVANCE CARE  \nPLANNING IMPLEMENTATION IN NURSING HOMES: A SYSTEMATIC REVIEW  \nPeiyuan Zhang1, Joan Davitt1, Nancy Kusmaul1, Paul Sacco2, Kathleen Unroe3, and John Cagle4, 1. University of Maryland, Baltimore County, Baltimore, Maryland, United States, 2.  \nUniversity of Maryland, Baltimore, Maryland, United States, 3. Indiana University School of Medicine, Indianapolis, Indiana, United States, 4. University of Maryland, Batimore, Maryland, United States  \nApproximately 1.2 million people resided in more than  \n15,000 nursing homes (NHs) in the U.S., with 30% spending their last days there. Advance care planning (ACP) has well-documented benefits in improving the quality of end-of-life care and thus has significant relevance to NHs. However, the  \nInnovation in Aging, 2025, Vol. 9, No. S2 769  \nquality of ACP practices varies partly due to a lack of ACP guidelines. This systematic review aimed to identify the key elements for successful ACP in NHs, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Three groups of terms representing ACP, implementation processes, and assessment were combined with “AND”and searched in four databases: CINAHL, PsycInfo, SocINDEX, and Medline (Ovid) in June 2024. The search yielded 2,013 studies, of which 83 were reviewed in full, and 19 met the inclusion criteria, validated through independent review and consensus by two researchers. Deductive thematic analysis of the selected studies following Donabedian’s model of quality of care identified two major themes with 11 subthemes: (1) NH structural support for ACP, including policies incorporating ACP into admission, role clarity, and resource availability (e.g., dedicated time and training for ACP, particularly among people with impaired decision-making capacity), and (2) standardized implementation processes, emphasizing resident and family engagement, trust building, discussions of care options and residents’ preferences, documentation of ACP in a standardized place, sharing ACP-related information among an interdisciplinary team, and reviewing ACP regularly. The findings highlight the need for structured support and standardized implementation processes, providing a framework for future NHACP quality improvement initiatives.","cbCaiivyN1GrbDpQ","https://ap.wps.com/l/cbCaiivyN1GrbDpQ","pdf",1348210,"English","# Background\n# Methods\n## Search strategy and inclusion process\n# Results\n## Theme 1: Nursing home structural support\n## Theme 2: Standardized implementation processes\n# Conclusion","[{\"question\":\"Why is advance care planning (ACP) important for nursing homes?\",\"answer\":\"ACP improves the quality of end-of-life care. In nursing homes, its benefits are especially relevant because many residents spend their last days there.\"},{\"question\":\"How was this systematic review conducted?\",\"answer\":\"The review followed PRISMA guidelines and searched four databases (CINAHL, PsycInfo, SocINDEX, Medline Ovid) in June 2024. From 2,013 studies, 19 were included after independent review and consensus.\"},{\"question\":\"What key elements support successful ACP implementation in nursing homes?\",\"answer\":\"The review found two major themes: (1) nursing home structural support (policies, role clarity, and resources such as dedicated time and training) and (2) standardized implementation processes emphasizing engagement, trust building, documented discussions, interdisciplinary information sharing, and regular review.\"}]","Elements for Successful Advance Care Planning Implementation in Nursing Homes - A Systematic Review | PDF",1790644853]