Introduction

Advance Care Planning(ACP) represents a patient-centered, voluntary, and continuous process, enabling individuals to articulate their values, goals, and preferences for future medical treatments with family, healthcare providers, and relevant stakeholders, particularly when they are of sound mind and capable of making informed decisions [1–3]. This process underscores the importance of dialogue among patients, their family, and healthcare professionals to reach consensus on healthcare choices, including clarifying values, appointing decision-makers, and finalizing pertinent documents [3]. ACP aims to honor patient autonomy, enhance care quality, strengthen relationships, prepare for end-of-life scenarios, and prevent overtreatment [4]. Research has consistently shown that ACP leads to positive outcomes for patients, their families [5], healthcare professionals [6], and the overall healthcare system [7]. For instance, Goswami et al. [8] demonstrated that ACP plays a crucial role in helping cancer patients comprehend their condition and prognosis, aiding them in making end-of-life care decisions. Liu et al. [5] also showed that ACP also enhances the alignment of end-of-life care between patients and caregivers, boosts caregivers confidence in decision-making, and improves communication quality during this critical period. In addition, it supports older adults in achieving goal-aligned care [9], resulting in reduced hospitalizations, less intensive end of life interventions, decreased medical expenses, and optimized resource utilization [7].

In current clinical practice, the significance of ACP as a pivotal strategy to enhance the quality of care for patients at the end of life has been widely acknowledged. In the process of implementing Advance Care Planning (ACP), we face numerous challenges that not only involve the perceptions and attitudes of patients, families, and healthcare providers, but also encompass institutional, cultural, and legal barriers [10–14]. The apparent deficiencies in understanding and effective implementation of ACP among patients, families, and healthcare providers can be largely attributed to the lack or inadequacy of ACP training [11–12]. As the healthcare environment continues to evolve and patient needs become increasingly complex, addressing these challenges requires comprehensive training programs for healthcare providers and educational programs for patients and families to ensure that ACP becomes an integral part of high-quality healthcare services.

Workshops have emerged as a widely adopted method to raise awareness about the importance of ACP and to promote the development of relevant skills [15–16]. These interactive learning and training sessions, typically conducted in small groups, are designed to foster skill development and learning through hands-on activities and participant engagement [15–16]. By engaging participants in practical exercises and discussions, workshops effectively enhance understanding of ACP and equip individuals with the necessary skills to implement it effectively. Evidence suggests that ACP workshops are effective in enhancing participants’ understanding, skills, confidence, and engagement with ACP, promoting broader implementation [17–20]. Such workshops have successfully increased multidisciplinary staff’s knowledge, self-efficacy, attitude, and comfort related to ACP discussions, while also addressing cultural and spiritual concerns [17–18]. Community-led, peer-facilitated ACP workshops have been found to improve public knowledge, motivation, and confidence in participating in ACP, ultimately enhancing their involvement [19]. Role-playing ACP workshops, specifically, assist students in recognizing the impact of high-quality cross-professional dialogues on the care patients receive [20].

Despite numerous studies showing the effectiveness of ACP workshops, there is still a knowledge gap in comprehensively evaluating and comparing different workshop formats and contents. Research on the most effective formats and contents for improving clinical practice remains inadequate. Therefore, a systematic comparison and comprehensive evaluation of ACP workshops is necessary. This necessity arises from the diversification of workshops, which cater to various target groups and focus on different skill enhancements, making it hard to identify the best approaches [20–22]. Consequently, decision-makers, researchers, or funders face difficulties in ascertaining the most effective design, thereby impeding informed decision-making or resource allocation. Additionally, variability in assessment standards across studies hinders result comparison [23], which may reduce the reusability of training resources. Finally, cultural and regional differences can influence workshop effectiveness and acceptance [24], which hinders the accumulation and dissemination of knowledge.

In summary, this study aims to fill this gap by systematically mapping ACP workshop literature, identifying employed methods, and assessing their effectiveness through a scoping review. This will provide insights into the most effective workshop formats for different target groups and skills, guiding future workshop design and implementation.

Objectives

This scoping review aims to systematically map existing literature about ACP workshops, provide an overview of the contents and effects of various ACP workshops, and identify limitations and gaps in knowledge to provide direction for improving and optimizing ACP training programs. To best address this, we will answer four sub-questions: (1) How many types of ACP workshops (differentiated by research populations, training content and location, etc.)?, (2) What are the characteristics of various ACP workshops (including but not limited to their purpose, target population, venue, training content, and learning resources)?, (3) What are the main outcomes of various ACP workshops? (4) What are the limitations and gaps in current literature?

Methods

Discussion

ACP workshop, as a pivotal strategy to foster doctor-patient communication [20], has increasingly gained prominence. However, despite the potential demonstrated by ACP workshops in improving participants’ understanding, skills, and confidence in ACP [17–20], the current literature lacks comprehensive information on the diversity and effectiveness of these workshops. Specifically, there is a dearth of systematic comparisons and syntheses regarding how different types of ACP workshops impact various target groups, such as healthcare professionals, medical students, and the general public, as well as their long-term effects on patient care quality and healthcare resource utilization. Consequently, this study aims to systematically map the existing literature through a scoping review methodology, providing a comprehensive overview of ACP workshops and identifying knowledge gaps to guide future research directions and practical applications.

This study employs the scoping review method, adhering to the JBI guidelines and the PRISMA-ScR framework [26–28], to ensure systematicity and comprehensiveness. This approach is well-suited for exploring the literature in the field of ACP workshops, as it enables the systematic collection, screening, extraction, and synthesis of existing research, thereby offering a detailed overview of ACP workshops [25]. Specifically, we employed a comprehensive search strategy utilizing the broad search terms ‘advance care planning’ and ‘workshop,’ along with their synonyms and related phrases, across multiple databases and platforms, and over a specified time range, to capture all relevant studies and minimize the risk of publication bias. Additionally, stringent and explicit inclusion and exclusion criteria were established, characterized by objectivity and reproducibility [27], to ensure that only studies meeting our predefined standards are included in the review. To further reduce the risk of selection bias, two reviewers will independently screen studies and resolve any discrepancies in study selection through discussion and consensus, ensuring an unbiased evaluation of each study. Furthermore, the study selection process, including reasons for inclusion and exclusion, will be documented in detail to ensure the transparency and reproducibility of our findings. Although scoping reviews typically do not involve detailed assessments of study quality, we have decided to use the Mixed Methods Appraisal Tool (MMAT) to evaluate the quality of the included literature [33]. A data extraction template has also been developed to standardize the data extraction process and minimize potential data extraction bias.

However, several limitations are acknowledged that may impact the generality of our findings. Firstly, the diversity and complexity of ACP workshops introduce a significant challenge to our data analysis. This variability in the quality and content of the related literature poses potential biases and heterogeneity, which could affect the validity and reliability of our conclusions. The inconsistent nature of ACP workshop implementations may limit our ability to draw broad, universal conclusions from the data. Secondly, the decision to include only English articles introduces a language bias, that may overshadow significant studies published in other languages. This language barrier not only restricts our dataset but also potentially underestimates the cultural nuances and differences in ACP practices across diverse cultural contexts. By focusing solely on English literature, we may miss crucial insights from non-English-speaking regions, thereby limiting the cross-cultural applicability of our findings. Lastly, the preponderance of studies focusing on short-term effects of ACP workshops presents another limitation. This emphasis on immediate outcomes restricts our understanding of the long-term impact and sustainability of ACP interventions. The lack of longitudinal studies may hinder our ability to assess the enduring effects of ACP workshops on patient care and end-of-life decision-making. During data extraction and synthesis, we will carefully consider these factors and strive to account for potential biases, acknowledge the limitations imposed by language and cultural constraints, and highlight the need for future research to address these gaps, particularly in the areas of cross-cultural ACP practices and long-term outcomes.

The findings of this review hold significant implications for ACP across medical education, clinical practice, and policy development. They offer the potential to enrich participants’ learning experiences, boost the implementation of ACP, and ultimately enhance patient decision-making, improve hospice care quality, and facilitate the efficient allocation and utilization of medical resources. Despite inherent limitations, this review lays a solid foundation for future research and practice in the realm of ACP workshops.

Future research could delve deeper into the effectiveness of specific types of ACP (Advance Care Planning) workshops by examining which formats, durations, and content are most beneficial for different participant groups. Additionally, cross-cultural comparative studies should be conducted to explore how ACP workshops are perceived and utilized in diverse cultural contexts, identifying any cultural-specific factors that may influence their effectiveness. Furthermore, long-term follow-up research is necessary to assess the sustained impact of ACP workshops on participants’ understanding, attitudes, and behaviors related to advance care planning, as well as to explore any potential changes in healthcare outcomes. These comprehensive approaches will enrich our understanding and application of ACP workshops.

Supporting information