Department of Critical Care Nursing, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan.
Department of Nursing Informatics, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan.
BMC Palliat Care. 2022 Oct 12;21(1):179. doi: 10.1186/s12904-022-01068-2.
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.
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).
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.
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.
接受高风险手术的患者存在健康状况突然恶化的风险。本研究旨在探讨开发两种患者决策辅助工具（PtDAs）的可行性，以帮助接受高风险手术的患者在危机中就其医疗保健做出知情决策。
该现场测试实施了两种符合研究人员为手术前患者制定的国际标准的 PtDAs。研究参与者为计划在日本一家急症护理医院手术后入住重症监护病房的患者及其家属。该研究采用混合方法。主要结局是使用 SURE 测试评估患者的决策满意度。次要结局是对术前讨论预先护理计划（ACP）的需求感知和心理健康状况。还对家属的代理决策信心（NRS：0-10，定量数据）进行了调查。此外，在出院后进行了访谈以评估 PtDAs 的可接受性。数据在提供 PtDAs 之前（术前门诊，基线：T0）和之后（住院期间：T1）以及出院后（T2、T3）收集。
共纳入 9 名患者，其中 7 名同意参与（包括家属）。SURE 测试评分（平均值±标准差）分别为 T0 时为 2.1±1.2，T2 时为 3.4±0.8，T3 时为 3.9±0.4。术前讨论 ACP 的需求分别为 T1 时为 8.7±1.3，T2 时为 9.1±0.9。对家庭代理决策的信心程度分别为 T0 时为 6.1±2.5，T1 时为 7.7±1.4，T2 时为 8.1±1.5。患者报告说，使用 PtDAs 提供了与家人分享想法的机会，并激发了他们开始规划生活计划。此外，患者希望在手术后与医疗专业人员分享和讨论他们的决策过程。
已开发、评估和接受了支持高风险手术患者 ACP 的 PtDAs。然而，它们并没有涉及患者与其家属的 ACP 治疗意愿的任何讨论。应指导医疗保健提供者为患者提供充分的支持。未来需要更大规模的研究来评估 PtDAs 的有效性。
