Background

Recent international guidelines describe advance care planning (ACP) as evolving from isolated communication tasks toward an iterative, collaborative process integrating goals-of-care (GOC) discussions, documentation, clinical and ethical reasoning. Simulation is a promising approach to support this evolution, yet its design and impact on ACP interprofessional collaborative practice remain unclear. This systematic review synthesised and evaluated the literature on multiprofessional and interprofessional simulation (MP-Sim, IP-Sim) for training healthcare students and professionals in ACP.

Methods

We addressed four questions on trainees, ACP tasks, simulation design, and outcomes. Six databases (CINAHL, EMBASE, ERIC, MEDLINE, PsycINFO, Web of Science) were searched from January 2010 to June 2025. Eligible studies used simulation with trainees from at least two professions to address ACP. Findings were synthesised using a Presage–Process–Product framework, and outcomes were classified according to Kirkpatrick’s levels. Study quality was appraised using the Medical Education Research Study Quality Instrument.

Results

28 studies (11 MP-Sim, 17 IP-Sim) included 4,081 participants (83% professionals, 17% students), predominantly physicians and nurses. Simulation programs predominantly targeted GOC conversations, with limited integration of documentation and clinical and ethical reasoning. Most simulations were conducted in hospital settings. Despite heterogeneous methods, studies reported positive outcomes on learner satisfaction, attitudes toward communication and teamwork, and, in some studies, GOC documentation. MP-Sim primarily supported rehearsal of profession-specific ACP tasks, whereas IP-Sim more often enabled collaboration in dyads and teams.

Conclusion

Simulation-based ACP training can be conceptualized through a dual continuum comprising professional integration (from multiprofessional participation to interprofessional collaboration) and task integration (from communication-focused part-task rehearsal to whole-task ACP practice). This dual continuum provides a practical lens for guiding simulation design towards greater interprofessional collaboration and whole-task ACP practice. Designing simulations that integrate GOC communication, documentation, clinical and ethical reasoning with interprofessional collaboration within longitudinal, multi-stakeholder scenarios may better prepare students and professionals for contemporary ACP practice.