有持续的关于预先护理规划对临终护理的影响的讨论，但尚无meta分析来澄清ACP对癌症患者的影响。为了探究ACP与癌症患者激进型和舒适型临终护理结果之间的关联和调节因素，我们搜索了五个数据库中在1990-2022年间发表的针对癌症患者样本的同行评议的观察研究/实验ACP特定研究。采用反方差加权法对比例比进行汇总，估计整体效应。从8,673篇文章中选出21篇符合条件，代表33,541名参与者和68个效应大小（54个激进型，14个舒适型）。ACP与化疗、重症监护、住院、住院七天以下的福利院使用、住院死亡和激进型护理复合指标的比例比显著降低。ACP与不复苏指令的比例比增加1.51倍有关。心肺复苏、急诊科住院、机械通气和福利院使用等其他结果没有受到影响。调节测试显示，ACP的沟通组成部分比其他组成部分（例如文件）更能显著降低住院率，并且观察研究而非实验研究更有利于提高福利院使用比例。该meta分析证明了ACP与癌症临终关怀之间关联的证据混杂不清，其中调节测试表明ACP的沟通组成部分对结果的影响更大。进一步的疾病特异性努力以澄清对患者和照护者有用和有意义的ACP模型和组成部分，将推动该领域的发展。发行版权©2023. Elsevier Inc.发布。

There is ongoing discourse about the impact of advance care planning (ACP) on end-of-life (EOL) care. No meta-analysis exists to clarify ACP's impact on patients with cancer.To investigate the association between, and moderators of, ACP and aggressive versus comfort-focused EOL care outcomes among patients with cancer.Five databases were searched for peer-reviewed observational/experimental ACP-specific studies that were published between 1990-2022 that focused on samples of patients with cancer. Odds ratios were pooled to estimate overall effects using inverse variance weighting.Of 8,673 articles, 21 met criteria, representing 33,541 participants and 68 effect sizes (54 aggressive, 14 comfort-focused). ACP was associated with significantly lower odds of chemotherapy, intensive care, hospital admissions, hospice use fewer than seven days, hospital death, and aggressive care composite measures. ACP was associated with 1.51 times greater odds of do-not-resuscitate orders. Other outcomes-cardiopulmonary resuscitation, emergency department admissions, mechanical ventilation, and hospice use-were not impacted. Tests of moderation revealed that the communication components of ACP produced greater reductions in the odds of hospital admissions compared to other components of ACP (e.g., documents); and, observational studies, not experimental, produced greater odds of hospice use.This meta-analysis demonstrated mixed evidence of the association between ACP and EOL cancer care, where tests of moderation suggested that the communication components of ACP carry more weight in influencing outcomes. Further disease-specific efforts to clarify models and components of ACP that work and matter to patients and caregivers will advance the field.Copyright © 2023. Published by Elsevier Inc.