End-of-life care can involve complex decisions, and patients’ preferences are particularly important. Advance care planning is a process that enables individuals to define goals and preferences for future medical treatment and care, discuss these with family and healthcare providers, and record and review these preferences if appropriate. However, preferences are not always stable and fixed, especially in complex and changing situations. It is important to review advance care planning documents as people’s illnesses progress, but current evidence does not clearly define how often, which aspects, or which patients should be prioritized. Understanding how and why preferences change or remain stable in older people’s populations will help provide relevant, up-to-date, and responsive advance care planning.
To further explore this, Robinson and colleagues (2025) conducted a scoping review to answer the question, ‘What is the nature of the current evidence about how and why the end-of-life care preferences of older people change over time?’
Screening identified 52 articles, reporting on 40 studies. A majority were longitudinal studies collecting quantitative data about treatment preferences. Other preference categories included euthanasia, balancing quality and length of life, goals of care, preferred place of death, decision-making and spiritual preferences. Studies explored a variety of factors that may influence preference change or stability. There was a lack of research with ethnic minority groups and people aged over 80.
Existing research has focused on preferences about specific therapies, at the expense of understanding what matters most to older people. Synthesis of the available evidence about why preferences change will guide reviews of patients’ advance care plans. To inform dynamic, person-centred end-of-life care we need studies prospectively exploring how older people construct a broader range of preferences, and negotiate these over time.
Source: Robinson, L., Dewhurst, F., Huggin, A., Stow, D., Stenson, C., Westhead, E., … & Paes, P. (2025). Exploring older people’s end-of-life care preferences over time: A scoping review. Palliative Medicine, 02692163251331161.
