Simulation training for advance care planning reviewed across 28 studies

A systematic review published in Advances in Simulation on 8 October 2026 examined how multiprofessional and interprofessional simulation is used to train healthcare students and professionals in advance care planning, the iterative process of discussing and documenting a person’s goals of care. The review, led by Thomas Fassier with colleagues including Karen Lister, Anu Mehra, Tyler J. Albert and Adeline Paignon, synthesised 28 studies covering 4,081 participants and mapped what the training programmes taught, how the simulations were designed and what outcomes they produced.

The authors framed their work against recent international guidelines that describe advance care planning as evolving from isolated communication tasks toward an iterative, collaborative process integrating goals-of-care discussions, documentation, and clinical and ethical reasoning. Simulation, in which learners rehearse conversations and decisions in realistic scenarios, is considered a promising way to support that evolution, but the review team noted that the design of such programmes and their impact on interprofessional collaborative practice had remained unclear. Their aim was therefore to synthesise and evaluate the literature on multiprofessional simulation, in which trainees from different professions learn alongside one another, and interprofessional simulation, in which learners actively collaborate across professional roles.

Methodologically, the review addressed four questions concerning trainees, the advance care planning tasks targeted, simulation design and outcomes. The researchers searched six databases, CINAHL, EMBASE, ERIC, MEDLINE, PsycINFO and Web of Science, from January 2010 to June 2025. Eligible studies had to use simulation with trainees from at least two professions to address advance care planning. Findings were synthesised using a Presage–Process–Product framework, outcomes were classified according to Kirkpatrick’s levels, which grade educational results from learner reactions through to broader system effects, and study quality was appraised with the Medical Education Research Study Quality Instrument.

The 28 studies comprised 11 multiprofessional simulation programmes and 17 interprofessional simulation programmes. Of the 4,081 participants, 83 percent were practising professionals and 17 percent were students, and the cohorts were predominantly made up of physicians and nurses. Most of the simulations were conducted in hospital settings. The technical picture that emerged was one of narrow task coverage: the programmes predominantly targeted goals-of-care conversations, while documentation and the clinical and ethical reasoning that surround those conversations were only limitedly integrated into the simulated scenarios.

Despite heterogeneous methods across the included studies, the review reported positive outcomes in several domains. Learner satisfaction and attitudes toward communication and teamwork were consistently favourable, and in some studies the training also improved goals-of-care documentation. Because the review classified outcomes using Kirkpatrick’s levels, these findings sit mainly at the levels of learner reactions, attitudes and, in a subset of studies, documented behaviour.

A central distinction in the findings concerned the type of professional integration the two formats supported. Multiprofessional simulation primarily supported rehearsal of profession-specific advance care planning tasks, meaning that learners from different professions practised their own roles in a shared space. Interprofessional simulation more often enabled collaboration in dyads and teams, requiring learners to coordinate their contributions across professional boundaries.

From this evidence the authors proposed a conceptual model: simulation-based advance care planning training can be understood through a dual continuum. The first axis is professional integration, running from multiprofessional participation to interprofessional collaboration. The second is task integration, running from communication-focused part-task rehearsal, in which learners practise a single component such as a conversation, to whole-task advance care planning practice, which combines communication with documentation and reasoning. The dual continuum is intended as a practical lens for guiding simulation design toward greater interprofessional collaboration and whole-task practice.

The review’s conclusion points toward a specific design recommendation grounded in its findings. Because the included programmes predominantly targeted goals-of-care conversations while leaving documentation and clinical and ethical reasoning largely outside the simulated scenarios, the authors argue that simulations integrating all of these elements with interprofessional collaboration, delivered within longitudinal, multi-stakeholder scenarios, may better prepare students and professionals for contemporary advance care planning practice. Such designs would place learners in scenarios that unfold over time and involve multiple stakeholders, mirroring the iterative and collaborative character that recent guidelines attribute to the process.

As a systematic review, the study synthesises previously published research rather than generating new training data, and its conclusions rest on the 28 eligible studies identified through the six-database search ending in June 2025. The predominance of physicians and nurses among the 4,081 participants, the hospital setting of most simulations and the heterogeneous methods of the included studies define the scope of what the review can say.

Subject of Research: Multiprofessional and interprofessional simulation training for advance care planning in healthcare education

Article Title: Multiprofessional and interprofessional simulation training for advance care planning: a systematic review

Article References: Fassier, T., Lister, K., Mehra, A., Albert, T. J., & Paignon, A. (2026). Multiprofessional and interprofessional simulation training for advance care planning: a systematic review. Advances in Simulation. https://doi.org/10.1186/s41077-026-00490-3

Image Credits: AI Generated

DOI: 10.1186/s41077-026-00490-3

Keywords: advance care planning, simulation training, interprofessional education, multiprofessional simulation, goals of care, systematic review, healthcare education, clinical communication, Kirkpatrick levels, medical education, Multiprofessional, interprofessional