Yamamoto Kanako
Critical Care Nursing, St. Luke's International University, Tokyo, JPN.
Cureus. 2024 Feb 14;16(2):e54175. doi: 10.7759/cureus.54175. eCollection 2024 Feb.
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.
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.
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.
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 life-sustaining 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.
目前正在探索如何加强对需要急诊和重症监护的患者的预先护理计划（ACP）支持。此外，很少有研究报告对这些患者及其家属的支持所产生的效果和影响。研究人员开发了一种患者决策辅助工具，以启动对计划术后进入重症监护病房的患者及其家属的ACP支持。本研究旨在在高风险手术前为患者提供ACP支持，并确定其影响。
本研究设计为定性研究。参与者包括10名预定在日本一家急症医院接受高风险手术后入住重症监护病房的患者及其家属。研究人员在患者入院前使用决策辅助工具实施ACP支持。以半结构化方式就参与者的经历以及出院后接受ACP支持的影响进行访谈。使用集成电路录音机进行访谈录音，随后逐字转录。采用定性描述方式进行分析。
在开始治疗前提供ACP支持促使患者思考维持生命的治疗方法并考虑理想的生活状态。通过了解治疗风险，患者能够冷静地承担并发症，并讨论他们的死亡率和术后生活。患者认为在重症监护病房接受治疗前获得ACP支持是一项宝贵的益处。出院后，他们希望促进与医生之间的共同决策。另一方面，家庭成员比患者更担心ACP相关话题。此外，患者及其家属认为在手术前很难讨论他们关于ACP的想法和愿望。
建议术前ACP支持可作为预期需要重症监护的患者的一个入门阶段，使他们能够思考自己对维持生命治疗的偏好。然而，即使患者及其家属意识到突然危机的风险，他们也很难公开讨论自己对维持生命治疗的想法。因此，当患者及其家属讨论ACP时，纳入医疗指导和咨询可能会更有效。这些ACP支持措施可能会增加家庭讨论、一致性以及与医生的共同决策。
