Keon-Cohen Zoe, Loane Heather, Romero Lorena, Jones Daryl, Banaszak-Holl Jane
School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia; Department of Anaesthesia, Austin Hospital, Heidelberg, VIC, Australia; Department of Anaesthesia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia; Department of Anaesthesia, Eastern Health, Box Hill, VIC, Australia.
Department of Anaesthesia, Mercy Hospital for Women, Heidelberg, VIC, Australia.
Br J Anaesth. 2025 May;134(5):1318-1332. doi: 10.1016/j.bja.2025.01.031. Epub 2025 Mar 19.
Advance care planning is well established in general medical wards, but its implementation in anaesthesia and perioperative care presents unique challenges. Effective communication and shared decision-making regarding treatment limitations are essential to clarify care goals and provide timely, high-quality end-of-life care. Terminally ill patients with complex care needs can experience a higher risk of postoperative mortality during anaesthesia.
This scoping review examines the literature describing when and how advance care planning has been studied in perioperative care, focusing on patient characteristics, the content of advance care planning discussions, and impact on patient outcomes. The study follows PRISMA-ScR guidelines. Articles were collected from MEDLINE, CENTRAL, and CINAHL databases, using search terms from MeSH and synonyms for anaesthesia, surgery and perioperative care, advance care planning, living wills or advance directives, goals of care and terminal care, resuscitation orders, shared decision-making, and palliative care discussions.
Advance care planning documentation varies across surgical specialties and settings, with higher rates in emergency and palliative surgery. Patient factors, such as age and comorbidities, impact completion of advance care planning. Structurally, the presence of interdisciplinary teams, increased decision-making aids, and structured discussions improve implementation. Barriers included a lack of consistency in terminology, poor timing of needed conversations, a lack of cultural sensitivities, and patient fears of abandonment and palliative care.
Further research is required to determine the most appropriate and beneficial methods and outcomes for implementing advance care planning into perioperative and end-of-life care, ensuring appropriate, timely, and patient-oriented care delivery.
预立医疗计划在普通内科病房已得到广泛应用，但在麻醉和围手术期护理中的实施面临独特挑战。就治疗限制进行有效的沟通和共同决策对于明确护理目标以及提供及时、高质量的临终护理至关重要。患有复杂护理需求的晚期患者在麻醉期间术后死亡风险可能更高。
本范围综述考察了描述围手术期护理中何时以及如何研究预立医疗计划的文献，重点关注患者特征、预立医疗计划讨论的内容以及对患者结局的影响。该研究遵循PRISMA-ScR指南。从MEDLINE、CENTRAL和CINAHL数据库收集文章，使用来自医学主题词表（MeSH）的检索词以及麻醉、手术和围手术期护理、预立医疗计划、生前遗嘱或预立指令、护理目标和临终护理、复苏医嘱、共同决策以及姑息治疗讨论的同义词。
预立医疗计划文件在不同外科专科和环境中存在差异，在急诊和姑息手术中的比例更高。年龄和合并症等患者因素会影响预立医疗计划的完成情况。在结构方面，跨学科团队的存在、更多决策辅助工具以及结构化讨论可改善实施情况。障碍包括术语缺乏一致性、所需谈话时机不佳、缺乏文化敏感性以及患者对被遗弃和姑息治疗的恐惧。
需要进一步研究以确定将预立医疗计划纳入围手术期和临终护理的最合适且有益的方法及结果，确保提供适当、及时且以患者为导向的护理。
