Trigger criteria for advance care planning in adults with congenital heart disease: a systematic review
Bibliographic record
Abstract
Abstract Background Adult patients with congenital heart disease (CHD) are at increased risk of premature morbidity and mortality. Advance care planning (ACP) is an underused resource to provide longitudinal comprehensive and patient-centered care in adults with CHD. Barriers to initiate ACP include, amongst others, the uncertainty when to initiate such talks and the fear of causing unnecessary emotional distress to patients. Criteria to initiate such discussions are not well defined. Purpose The aim of this study was to perform a systematic literature review to identify previously proposed triggers to initiate ACP in adults with CHD. Methods MEDLINE, Embase, PsycInfo, CINAHL, Web of Science, Scopus and the Cochrane Library were searched from the inception of the database to July 26, 2024. The core concepts of the search strategy consisted of 1) Adult CHD, and 2) Advance care planning or palliative care. Three investigators independently reviewed each report for inclusion and then extracted potential trigger criteria for initiation of ACP talks. Potential trigger criteria were categorized thematically as time-based, need-based, disease-based or prognosis-related. Results Of 4257 articles screened, 21 were included for data extraction. The majority of articles (66%) were published between 2019-2023, and in cardiology journals (86%). ACP was recommended to be offered to adult CHD patients during routine follow-up in 15 articles (71% of all articles), independent of defect complexity or underlying functional status. Specific interventions were the second most frequently cited trigger criteria (11 articles, 52%), followed by signs of disease progression (9 articles, 43%) and defect-specific triggers (7 articles, 33%). Symptom- and patient-based triggers were reported less frequently. For details see table 1. Conclusion The results of this systematic review highlight the variety of triggers and lack of consensus criteria to initiate ACP in adults with CHD. Further research is needed to identify appropriate and timely trigger criteria.Table 1 Table 1 cont
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.018 | 0.106 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.008 | 0.008 |
| Bibliometrics | 0.012 | 0.012 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.004 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".