ACP in Elective Surgery Patients: A Pilot Study

February 23, 2024
3 min
Dr. Rick Aizpuru, VP Clinical Solutions

Are there hidden benefits for families and patients to begin the conversation concerning one’s best life before elective surgical procedures? In the recently published article, “Impact of advance care planning support on patients treated in the ICU after high-risk surgery,” the author K. Yamamoto sheds light on the importance of integrating advance care planning (ACP) into the pre-operative process. The study researched the impact of advance care planning support for patients treated in the ICU after high-risk surgery. Researchers describe benefits for patients and families by beginning the conversation before elective procedures commence. 

Advancements in medical care have resulted in older and higher risk patients with serious illnesses having increased opportunities for elective surgery. Patients who undergo high-risk surgery or intensive care unit interventions and their loved ones are in an increased state of anxiety and stress. After surgery, many of these patients may receive care in an intensive care setting. When patients are in the most critical stage of care, this is not an optimal situation to necessarily make the critical choices about the intensity of one’s care choices.

The unintended consequence of some life sustaining measures in the ICU may result in permanent changes in one’s quality of life. The medical, physical, and neurocognitive consequences of certain care choices or interventions may not align with the patient’s choices of the end of life. Often these ICU driven decisions need to be made quickly without full consideration of outcomes or utilizing optimal shared medical decision making.

Completing ACP proactively allows patients to communicate their wishes regarding life-sustaining measures, medical interventions, and end-of-life care. This information becomes invaluable for healthcare professionals, especially in the context of elective surgeries where unexpected complications may arise. When healthcare providers have access to comprehensive ACP documentation, they can tailor treatment plans to align with the patient's goals and preferences. By integrating ACP into the pre-operative process, healthcare providers contribute to a more comprehensive and personalized approach to elective surgeries. 

The study concludes ACP initiation and completion before elective surgery may be a good starting place for patients and families. Furthermore, when evaluating associated risk with a given surgical procedure, this may prompt patients and families to contemplate the quality of life they envision and desire post treatment. This also may help providers to think more independently about their treatment and to be better participants in shared medical decision-making with their patients. 

As we strive for patient-centered care, prioritizing advance care planning in the elective surgery context becomes a cornerstone in fostering informed decision-making, respecting patient autonomy, and ensuring the highest quality of healthcare delivery. This article is an excellent reminder that when you or your loved ones are faced with a medical emergency, prior completion of your ACP can be instrumental in getting the appropriate level of care. Ideally, ACPs are best completed without the pressure of an upcoming elective surgery. Still, I think, we know that clearly prior to an elective procedure appointing a Healthcare Power of Attorney and discussing one’s healthcare directives are as important as one’s preop physical. 

Beginning a conversation around one’s best life optimally would occur before the need for surgery, but this study helps to validate the importance of the process, even though it is as studies have shown to be a less than optimal time.

If you are interested in starting your ACP conversation, schedule with Thanacare today.