For families navigating a dementia diagnosis, the window for meaningful end-of-life planning closes gradually but inevitably. New systematic evidence clarifies which communication approaches can open that window before cognitive decline forecloses the conversation entirely — a finding with direct implications for clinicians, caregivers, and healthcare systems managing the growing dementia burden.
This mixed-methods systematic review, registered on PROSPERO and drawing from five major databases, screened 517 articles and ultimately included ten studies examining communication strategies designed to improve advance care planning (ACP) readiness in people living with dementia and their family caregivers. The evidence base spanned quantitative, qualitative, and mixed-methods designs. Eight of the ten studies evaluated structured interventions — including facilitated ACP discussions, educational programs, and self-paced stepwise decision-support tools. Multi-component approaches that combined guided dialogue, educational content, and structured tools showed the most consistent gains in readiness, though effect sizes varied across subgroups and outcomes were not uniformly stable over time. The remaining two studies examined communication methods themselves, highlighting patient-centered language and relational framing as key facilitative elements.
This review arrives at a moment when dementia prevalence is accelerating globally and healthcare systems face mounting pressure to shift end-of-life planning earlier in the disease trajectory. The finding that no single strategy dominates — but that layered, multi-component approaches outperform simpler interventions — aligns with what the broader palliative care literature suggests about complex behavioral change. The small number of included studies (ten from 517 screened) underscores a significant evidence gap and limits the strength of any causal conclusions. Most included studies likely differ in population demographics, disease stage, and cultural context, making generalizability uncertain. This review is best characterized as confirmatory of the value of structured multi-component approaches rather than paradigm-shifting — but it provides a useful synthesis for practitioners designing ACP programs for early-to-moderate dementia populations.