{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T15:45:10Z","timestamp":1777650310744,"version":"3.51.4"},"reference-count":46,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Lien Centre for Palliative Care"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Goals of care discussions (GOCDs) are critical for patients with serious illnesses but are hindered by clinician-level barriers. Nudges\u2014low-burden, behaviourally informed strategies that influence clinician behaviour without restricting choice\u2014may provide a scalable approach to increase GOCDs. We systematically reviewed and meta-analysed the effect of clinician-directed nudges on GOCD documentation. Secondary outcomes were quality of communication and healthcare utilisation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched three databases (2004\u20132024). Nudges were classified using the MINDSPACE framework. Random-effects meta-analysis estimated pooled odds ratios (ORs) with 95% confidence intervals (CIs) for GOCD documentation. Subgroup analyses examined nudge type, study design and co-interventions. Secondary outcomes were narratively synthesised.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Fifty-one studies were included (16 randomised trials, 7 non-randomised controlled studies and 28 pre-post studies). Salience-based nudges, which make key information more noticeable, were most common (86% of interventions). Most interventions (87%) were multicomponent. Nudges increased GOCD documentation (OR 3.30, 95% CI 2.40\u20134.53). Multicomponent interventions with a nudge component had larger effects than nudges alone (OR 4.03 vs. 1.89; P\u2009=\u2009.03). No differences were observed by nudge types or study designs. Heterogeneity was high (I2\u00a0=\u200996.7%) but leave-one-out sensitivity analyses supported robustness. Nudges improved quality of communication (2\/2 studies) and reduced readmissions (2\/2), with inconsistent effects on palliative care referrals (5\/19) and no impact on hospital length of stay (0\/5).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Clinician-directed nudges improve GOCD documentation and represent a scalable, low-cost strategy for quality improvement. Future research should examine a broader range of nudges, multilevel interventions and effects on the quality and timing of GOCDs across settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ageing\/afag113","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T11:26:42Z","timestamp":1776770802000},"source":"Crossref","is-referenced-by-count":0,"title":["Enhancing goals of care discussions: a systematic review and meta-analysis of clinician-directed behavioural nudges"],"prefix":"10.1093","volume":"55","author":[{"given":"Louisa","family":"Poco","sequence":"first","affiliation":[{"name":"Duke-NUS Medical School ,","place":["Singapore"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shimoni","family":"Shah","sequence":"additional","affiliation":[{"name":"Lien Centre for Palliative Care, Duke-NUS Medical School , 8 College Road, Singapore 169547 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