Impact of Advance Care Planning Support on Patients Treated in the Intensive Care Unit After High-Risk Surgery

Abstract

Introduction: Efforts to enhance support for advance care planning (ACP) in patients requiring emergency and intensive care are currently being explored. In addition, few studies have reported the effects and impact of support for these patients and their families. The researcher developed a patient decision aid to initiate support for ACP for patients who plan to enter the intensive care unit after surgery and their families. This study aimed to provide ACP support to patients before high-risk surgery and to determine its impact.Methods: The study design was qualitative. The participants included 10 patients who were scheduled to be admitted to the intensive care unit after high-risk surgery at an acute-care hospital in Japan, and the patients' families. The researcher used decision aids to implement ACP support before the patients were admitted. Participants were interviewed in a semi-structured manner regarding their experiences and the impact of receiving ACP support after discharge. Interviews were recorded using an integrated circuit recorder, followed by verbatim transcripts. The analysis was performed in a qualitative descriptive manner.Results: ACP support prior to treatment initiation led patients to think about life-sustaining treatments and consider ideal living. By understanding the risks of treatment, patients can calmly assume complications and discuss their mortality and life after surgery. Patients perceived receiving ACP support as a valuable benefit prior to undergoing treatment in the intensive care unit. After discharge, they wanted to promote shared decision-making among their physicians. On the other hand, family members were more anxious about ACP topics than patients. In addition, the patients and their families felt that it was difficult to discuss their thoughts and wishes regarding ACP before surgery. Conclusion:It is suggested that pretreatment ACP support could serve as an introductory phase for patients anticipating the need for intensive care, allowing them to contemplate their preferences regarding lifesustaining treatment. However, it is difficult for patients and their family members to openly discuss their thoughts on life-sustaining treatment, even if they are aware of the risk of a sudden crisis. Therefore, when patients and their families discuss ACP, the inclusion of healthcare coaching and counseling may be more effective. These measures of ACP support could add to increased family discussions, concordance, and shared decision-making with physicians.

Families’ Experiences of Surrogate Decision-Making and Challenges of Shared Decision- Making: A Cross-Sectional Study

“…It is important to educate surrogates on how to make decisions that respect the patient's autonomy [22]. It is essential to support the family in making the best treatment decision for the patient, while also listening to their wishes and thoughts and reinforcing their mental care so that the decision is acceptable not only to the patient but also to the family [26].…”

“…One conjecture is that decision-making was not based on medical information alone. Family members who make surrogate decisions regarding patient treatment bear a huge responsibility and burden [22]. Considering the patient's autonomy by discussing the topic among the family members is essential [23].…”

“…Surrogates are expected to make critical decisions while dealing with crises and anxiety caused by the event. Healthcare professionals need to assist the family in making surrogate decisions that respect the patient's autonomy while providing emotional support for the surrogate's crisis state [6,22,27].…”