Advance Care Planning for Intensive Care Patients During the Perioperative Period: A Qualitative Study

Yamamoto, Kanako; Yonekura, Yuki; Hayama, Junko; Matsubara, Taketo; Misumi, Hiroyasu; Nakayama, Kazuhiro

doi:10.1177/23779608211038845

Cited by 11 publications

(17 citation statements)

References 28 publications

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“…These findings suggest that a patient’s recovery may reduce the need for ACP and weaken the perception that patients want to be treated. Further, the literature reveals preferences regarding end-of-life care change for patients who recover after ICU treatment [ 28 ], as healthcare providers find it challenging to continue the discussion on patient preferences over the course of the treatment [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Patients who have undergone high-risk surgery and have been admitted to ICUs show willingness to discuss ACP in advance to ensure that their treatment preferences are respected and to minimise the burden on family members toward the end of their life [ 28 ]. At the same time, an increasing number of healthcare providers are positively considering the provision of ACPs support to patients [ 21 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

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Healthcare providers’ perception of advance care planning for patients with critical illnesses in acute-care hospitals: a cross-sectional study

2022

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Background In acute-care hospitals, patients treated in an ICU for surgical reasons or sudden deterioration are treated in an outpatient ward, ICU, and other multiple departments. It is unclear how healthcare providers are initiating advance care planning (ACP) for such patients and assisting them with it. The purpose of this study is to clarify healthcare providers’ perceptions of the ACP support provided to patients receiving critical care in acute-care hospitals. Methods A cross-sectional study was conducted using questionnaires. In this study, 400 acute-care hospitals with ICUs in Japan were randomly selected, and 1490 subjects, including intensivists, surgeons, ICU nurses, surgical floor nurses, and surgical outpatient nurses, participated. Survey items examined whether ICU patients received ACP support, the participants’ degree of confidence in providing ACP support, the patients’ treatment preferences, and the decision-making process, and whether any discussion was conducted on change of values. Results Responses were obtained from 598 participants from 157 hospitals, 41.4% of which reportedly supported ACP provision to ICU patients. The subjects with the highest level of ACP understanding were surgeons (45.8%), and differences in understanding were observed across specialties (P < 0.001). Among the respondents, physicians and nurses expressed high levels of confidence in providing ACP support to patients requiring critical care. However, 15.2% of all the subjects mentioned that they would not attempt to resuscitate the patients. In addition, 25.7% of the participants handed over patients’ values to other departments or hospitals, whereas 25.3% handed over the decision-making process. Conclusions Among the participating hospitals, 40% provided ACP support to patients receiving critical care. The low number is possibly because support providers lack understanding of the content of patients’ ACP or about how to support and use ACP. Second, it is sometimes too late to start providing ACP support after ICU admission. Third, healthcare providers differ in their perception of ACP, widely considered an ambiguous concept. Finally, in acute-care hospitals with different healthcare settings, it is necessary to confirm and integrate the changes in feelings and thoughts of patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Healthcare providers’ perception of advance care planning for patients with critical illnesses in acute-care hospitals: a cross-sectional study

2022

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“…The PtDAs used for this study were developed following a systematic model development process [15] (Additional le 1) by the researchers based on a survey of the needs of patients and families who had undergone high-risk surgery and the healthcare providers [9,16]. The Ottawa decision support framework conceptualizes the support patients, families, and healthcare providers need for di cult decisions [16,17].…”

Section: Ptdasmentioning

confidence: 99%

“…However, ACP is not routinely implemented in advance, and advance directives (ADs) are not required to be documented. By understanding the possible risks during high-risk surgical operations, providing support to those who wish to explore and de ne the treatment they wish to receive in advance can lead to patient-centered care in any treatment setting [9].…”

Section: Introductionmentioning

confidence: 99%

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

Yamamoto

Kaido

Yokoi

et al. 2022

Preprint

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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.

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“…Despite this, consideration of end-of-life care for perioperative patients has historically been a taboo among surgeons [ 8 ]. In addition, there is a fear that patients may not receive appropriate lifesaving treatment if they express their wishes for end-of-life care and inform physicians before surgery [ 9 ]. While ensuring that patients receive appropriate life-saving treatment, they are entitled to medical care with confidence, and their autonomy should always be respected, so that they do not receive inappropriate treatment or continue to live in an unwilling state.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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Background Patients undergoing high-risk surgery are at a risk of sudden deterioration of their health. This study aimed to examine the feasibility of the development of two patient decision aids (PtDAs) to assist patients undergoing high-risk surgeries in informed decision-making about their medical care in a crisis. Methods This field testing implemented two PtDAs that met the international criteria developed by the researchers for patients before surgery. Study participants were patients scheduled to be admitted to the intensive care unit after surgery at one acute care hospital in Japan and their families. The study used a mixed-methods approach. The primary outcome was patients’ decision satisfaction evaluated by the SURE test. Secondary outcomes were the perception of the need to discuss advance care planning (ACP) before surgery and mental health status. The families were also surveyed on their confidence in proxy decision-making (NRS: 0–10, quantitative data). In addition, interviews were conducted after discharge to assess the acceptability of PtDAs. Data were collected before (preoperative outpatients, baseline: T0) and after providing PtDAs (in the hospital: T1) and following discharge (T2, T3). Results Nine patients were enrolled, of whom seven agreed to participate (including their families). The SURE test scores (mean ± SD) were 2.1 ± 1.2 (T0), 3.4 ± 0.8 (T2), and 3.9 ± 0.4 (T3). The need to discuss ACP before surgery was 8.7 ± 1.3 (T1) and 9.1 ± 0.9 (T2). The degree of confidence in family surrogate decision-making was 6.1 ± 2.5 (T0), 7.7 ± 1.4 (T1), and 8.1 ± 1.5 (T2). The patients reported that using PtDAs provided an opportunity to share their thoughts with their families and inspired them to start mapping their life plans. Additionally, patients wanted to share and discuss their decision-making process with medical professionals after the surgery. Conclusions PtDAs supporting ACP in patients undergoing high-risk surgery were developed, evaluated, and accepted. However, they did not involve any discussion of patients’ ACP treatment wishes with their families. Medical providers should be coached to provide adequate support to patients. In the future, larger studies evaluating the effectiveness of PtDAs are necessary.

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Advance Care Planning for Intensive Care Patients During the Perioperative Period: A Qualitative Study

Cited by 11 publications

References 28 publications

Healthcare providers’ perception of advance care planning for patients with critical illnesses in acute-care hospitals: a cross-sectional study

Healthcare providers’ perception of advance care planning for patients with critical illnesses in acute-care hospitals: a cross-sectional study

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

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

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