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BMC Palliative Care

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Open Access 01-12-2022 | Care | Research

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

Authors: Kanako Yamamoto, Toshimi Kaido, Tadao Yokoi, Gen Shimada, Takashi Taketa, Kazuhiro Nakayama

Published in: BMC Palliative Care | Issue 1/2022

Abstract

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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Title: Implementation of advance care planning decision aids for patients undergoing high-risk surgery: a field-testing study
Authors: Kanako Yamamoto
Toshimi Kaido
Tadao Yokoi
Gen Shimada
Takashi Taketa
Kazuhiro Nakayama
Publication date: 01-12-2022
Publisher: BioMed Central
Keyword: Care
Published in: BMC Palliative Care / Issue 1/2022
Electronic ISSN: 1472-684X
DOI: https://doi.org/10.1186/s12904-022-01068-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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