Blackwood Douglas H, Vindrola-Padros Cecilia, Mythen Monty, Walker David
Centre for Anaesthesia and Perioperative Medicine, University College London Division of Surgery & Interventional Science, London, UK.
Department of Anaesthesia and Perioperative Medicine, University College Hospital, London, UK.
BMJ Open. 2025 Aug 28;15(8):e101642. doi: 10.1136/bmjopen-2025-101642.
Advance care planning (ACP) allows patients to detail their wishes in case they lose capacity. Despite low mortality rates, the high volume of surgery means that thousands of people die in the weeks and months following an operation. Perioperative ACP may benefit patients at high risk of complications and death by allowing them to discuss and document their priorities.
To assess UK anaesthetists' knowledge, attitudes and practice regarding ACP and explore perceived barriers to perioperative ACP.
Explanatory sequential mixed methods study, comprising a national online survey followed by qualitative interviews and observations. Data were integrated by using survey findings to shape the qualitative component, analysing both components for convergence and synthesising results into an explanatory narrative.
The quantitative survey was distributed to anaesthetists across the UK. The qualitative component (interviews and direct observations) was conducted at a single central London teaching hospital.
For the survey, 534 anaesthetists were invited, with 184 (34%) responding. A minimum sample of 94 was required, determined by Cochran's formula. 14 consultant anaesthetists participated in semistructured interviews, and 40 hours of observations were conducted in preoperative assessment clinics and multidisciplinary meetings.
The quantitative outcome was anaesthetists' knowledge, attitudes and self-reported practice of ACP. The qualitative outcome was identification of barriers and facilitators to perioperative ACP through thematic analysis of interviews and observations.
Most survey respondents (92%) endorsed ACP and 54% reported having an ACP discussion at least once every 6 months. Knowledge of ACP was found to be high with eight out of 10 questions answered correctly by the majority of respondents. While 78% indicated the run-up to major surgery is an appropriate time to discuss ACP, these conversations were not routinely integrated into practice. Qualitative findings highlighted three core reasons why treatment limitations are often not enacted perioperatively: (1) relatively low perceived postoperative mortality risk; (2) reversible nature of many surgical complications; and (3) the notion that if a patient truly requires treatment limitations, surgery may be inappropriate. Additional barriers included the focus on physical optimisation in pre-assessment clinics; a lack of clarity over the anaesthetist's role in leading these discussions; and an unclear role of the anaesthetist in the surgical pathway.
This study is the first to systematically describe UK anaesthetists' ACP knowledge, attitudes and practice. Barriers include perceptions of low mortality risk, reversible complications, pre-assessment focus on physical health and cancellation avoidance, and an unclear role of the anaesthetist.
预先护理计划（ACP）使患者能够详细说明其在丧失行为能力情况下的意愿。尽管死亡率较低，但大量的手术意味着成千上万的人在术后数周和数月内死亡。围手术期的预先护理计划可能使有并发症和死亡高风险的患者受益，因为这能让他们讨论并记录自己的优先事项。
评估英国麻醉医生关于预先护理计划的知识、态度和实践，并探讨围手术期预先护理计划的感知障碍。
解释性序列混合方法研究，包括全国在线调查，随后进行定性访谈和观察。通过利用调查结果来塑造定性部分，分析两个部分的趋同性并将结果综合成一个解释性叙述，从而整合数据。
定量调查分发给英国各地的麻醉医生。定性部分（访谈和直接观察）在伦敦市中心的一家教学医院进行。
对于调查，邀请了534名麻醉医生，184人（34%）做出回应。根据 Cochr an公式确定所需的最小样本量为94。14名麻醉科顾问参与了半结构化访谈，并在术前评估诊所和多学科会议中进行了40小时的观察。
定量结局是麻醉医生关于预先护理计划的知识、态度和自我报告的实践。定性结局是通过对访谈和观察进行主题分析来确定围手术期预先护理计划的障碍和促进因素。
大多数调查受访者（92%）认可预先护理计划，54%报告至少每6个月进行一次预先护理计划的讨论。发现麻醉医生对预先护理计划的知识水平较高，大多数受访者能正确回答10个问题中的8个。虽然78%表示重大手术前的准备阶段是讨论预先护理计划的合适时机，但这些谈话并未常规纳入实践。定性研究结果突出了围手术期治疗限制往往未得到执行的三个核心原因：（1）术后死亡风险的感知相对较低；（2）许多手术并发症的可逆性；（3）认为如果患者真正需要治疗限制，手术可能不合适。其他障碍包括术前评估诊所对身体优化的关注；麻醉医生在主导这些讨论中的角色缺乏明确性；以及麻醉医生在手术流程中的角色不明确。
本研究首次系统描述了英国麻醉医生的预先护理计划知识、态度和实践。障碍包括对低死亡风险的认知、可逆性并发症、术前对身体健康的关注和避免取消手术，以及麻醉医生角色不明确。
