Bridging the Gap: A Scoping Review of Clinical Decision Support Systems in End-of-Life Care for Older Adults.

BACKGROUND: Clinical decision support (CDS) systems have been widely adopted in health care to enhance decision making, but opportunities to refine their application in end-of-life (EOL) care for older adults remain. Despite the potential of CDS tools to facilitate timely hospice referrals and improve palliative care planning, challenges such as eligibility complexities, late referrals, and integration into clinical workflows persist. This scoping review maps the current landscape of CDS systems in EOL care, identifies key system types, and examines their effectiveness in guiding clinical decisions. METHODS: Following Arksey and O'Malley's framework, we conducted a comprehensive scoping review across PubMed, MEDLINE, CINAHL, APA PsycInfo, and other databases. Eligible studies included those focusing on the development, implementation, or evaluation of CDS systems in EOL care for older adults. Data extraction included CDS system types, targeted diagnoses, study design, intervention outcomes, and reported facilitators and barriers. RESULTS: A total of 31 studies were included, categorizing CDS systems into prognostic tools, referral tools, and care informing tools. Prognostic tools were the most common, assisting in predicting mortality risk and guiding referral timing. Referral tools supported structured hospice eligibility assessments, while care informing tools facilitated patient-provider discussions on care goals. CDS system effectiveness varied, with some tools improving palliative care referrals and advanced care planning, while others faced barriers related to staff adoption, regulatory concerns, and technological integration. CONCLUSIONS: CDS systems hold promise in bridging gaps in EOL decision making, but their implementation faces challenges, including workflow integration, clinician adoption, and disparities in accessibility. Future research should explore artificial intelligence-driven CDS tools, strategies to enhance provider trust, and tailored interventions for nursing home settings to optimize EOL care for older adults.