Implementation of advance care planning decision aids for patients undergoing high-risk surgery: A field-testing study

Abstract Background: Patients undergoing high-risk surgery are at risk of sudden changes in worsening. Advance care planning (ACP) support for patients who want active treatment is insufficient in setting outcomes, as it only targets better end-of-life care. Therefore, it is necessary to clarify how ACP support is implemented in the field and its effects. This study aimed to assess whether the development of two patient decision aids (PtDAs) can support preoperative ACP in patients undergoing high-risk surgeries.Methods: This field-testing implemented two PtDAs that met the international criteria developed by the researchers to patients before surgery. The study participants included patients who were scheduled to be admitted to the intensive care unit after surgery at one acute care hospital in Japan and their families. The primary outcome was decision satisfaction evaluated by the SURE test, and the secondary outcomes were perception of the need to discuss ACP before surgery and mental health status. Data were collected before (preoperative outpatients, baseline) and after providing PtDAs (in the hospital) and after discharge. Results were analyzed using a mixed-methods approach.Results: Nine patients were enrolled, of whom seven and their families agreed to participate. The SURE test result after discharge was four points (indicating no decisional conflict) for patients who were able to discuss with the researcher, patient, and family before discharge. Assisting patients with ACP before undergoing a high-risk surgery allowed them to recognize in advance the need for ACP, have an opportunity to share their thoughts with family members, and begin planning their own lives. Patients and their families were prepared to promote shared decision-making with healthcare providers and implement ideas into action.Conclusions: Two PtDAs supporting ACP in patients undergoing a high-risk surgery were developed, evaluated, and accepted; however, they did not involve any discussion of patients’ ACP treatment wishes with their families. Medical personnel should be coached to connect with adequate support. PtDAs for ACP before surgery could promote shared decision-making among patients, families, and healthcare providers.