Advance-care-planning and end-of-life discussions in the perioperative period: a review of healthcare professionals' knowledge, attitudes, and training

Abstract

Whilst the risk of dying after an operation in the UK is very small, the volume of surgery means that there are 20 000e25 000 deaths each year. For these patients and others who suffer major complications, critical illness often leads to a loss of capacity. If wishes are not discussed in advance, the patients may be excluded from meaningful involvement in decisions affecting their care. The preoperative period has been postulated as one where advance care planning could begin by engaging in voluntary conversations about an individual's wishes, priorities, and values should he/she loses capacity. There remain unanswered questions as to whether healthcare professionals are supportive of a move towards better engagement in such discussions with patients. Even if the reception to the idea is positive, it is clear that appropriate training and understanding will be required. The aims of this review were to describe the current knowledge and attitudes of healthcare professionals towards advance care planning in the perioperative setting, and to outline any educational programmes or training limitations that have been identified. Seven articles that met the inclusion criteria were identified. They indicate that healthcare professionals mostly have a positive view of advance care planning in the perioperative period, and there is little training or educational content available. Despite this, most healthcare professionals report feeling well equipped to have such discussions. Evidence was not found of advance care planning becoming a routine part of training or practice in the care of patients in the lead up to high-risk surgery.

Chronic and Sudden Serious Illness, COVID-19, and Decision-Making Capacity: Integrating Advance Care Planning Into the Preoperative Checklist for Elective Surgery

“…8 Likewise, a review of ACP and end-of-life discussions in the perioperative period found that, although providers seemed to view these discussions positively, limited educational and training content was available. 9 Despite the limited evidence to this point regarding perioperative ACP, there are a few populations where this approach has been studied. In 2018, Kata et al 10 studied the addition of ACP discussions to the preoperative process for elderly patients and found that it increased the number of designated surrogates, AD, and documents scanned into the medical record.…”

Recurrent oral squamous cell carcinoma‐incorporating advance care planning in education and practice

“…There is also an opportunity to educate future dentists about their impact by participating in an important, albeit difficult journey with their patients who are terminally ill or facing life-threatening disease or procedures. 20,21 Training for oral healthcare professionals to educate patients about their ACP options and guidance in navigating this process is sparse. This is not only an important element of dental education, but also an essential element of training for any healthcare professional involved in high-risk interventions.…”

“…There is also an opportunity to educate future dentists about their impact by participating in an important, albeit difficult journey with their patients who are terminally ill or facing life‐threatening disease or procedures . Training for oral healthcare professionals to educate patients about their ACP options and guidance in navigating this process is sparse.…”

Recognising the elephant in the room: Foundation doctors and anticipatory care planning

“…The literature supports this assertion as ACP is not routinely included in the perioperative period leading to high-risk surgery. 8 The impact of the variation in attitude towards ACP between specialties requires further exploration. From the foundation doctors' perspective (theme A), the complexity of decision making within surgical and some interventional specialties was a barrier to holding ACP discussions due to limited experience.…”