Abstract Background Advance directives (ADs) play a fundamental role in guiding end-of-life (EOL) care, yet patient preferences regarding surrogate decision-making, life-sustaining treatments (LSTs), and cardiopulmonary resuscitation (CPR) fluctuate extensively. Understanding these preferences is crucial for person-centered and culturally sensitive advance care planning (ACP), particularly heart failure patients. Methods A systematic review and meta-analysis were conducted to evaluate patient preferences regarding ADs. Databases including PubMed, Scopus, Web of Science, and Embase were searched for studies published up to March 6, 2024 that reported on preferences related to surrogate decision-making, LSTs, or CPR in patients with heart failure. Data was pooled using a random-effects model. Sensitivity analyses were conducted to assess the influence of outlier studies. Risk of publication bias was evaluated using Begg’s and Egger’s tests. Results Thirteen studies involving varied international populations were included. The pooled estimate of patients preferring surrogate decision-making was 53.66% (95% CI: 16.9%–90.43%), increasing to 71% (95% CI: 51.64%–91.34%) after excluding an outlier. Preference for receiving LSTs was 48.8% (95% CI: 37.84%–59.77%), increasing to 52.28% (95% CI: 35.95%–59.88%) after exclusion of one study. The pooled proportion of patients preferring to refuse CPR was 43.32% (95% CI: 29.13%–57.52%). Cultural factors, health status, and prior communication influenced these preferences. No significant publication bias was identified. Conclusion Preferences regarding ADs among patients with heart failure are diverse and influenced by cultural setting, disease morbidity, and prior ACP discussions. A substantial proportion of patients prefer surrogate decision-making and limited life-prolonging interventions. These findings highlight the need for culturally sensitive, personalized ACP that accommodates developing patient values and decision-making roles over time.
Khaleghparast et al. (Mon,) studied this question.