Advance Care Planning of Patients Undergoing High-Risk Surgery: A Concept Analysis

Abstract Background Many patients undergoing high-risk surgery receive critical care after surgery, yet there is a risk that their condition may deteriorate. Therefore, patients are advised to engage in advance care planning (ACP) by selecting treatment preferences in preparation for potential complications or adverse outcomes. The aim of this research was to clarify the concept of ACP for patients undergoing high-risk surgery. Methods The Walker & Avant’s approach to concept analysis was used. The reviewed literature was sourced from PubMed, EMBASE, Ichushi-Web, and CiNii databases as well as guidelines and books. The search was conducted by using keywords that were a combination of the following A, B, and C terms: A, advance care planning, advance directive, or living will; B, critical care or intensive care unit; and C, perioperative. Results Five attributes of ACP were extracted: the promise of appropriate treatment, definition of life-prolonging treatment, customization of life-saving care, expression of treatment inclinations and discretion, and continuous plan revision and transition. In addition, two antecedents were extracted: the recognition of expected risks and need for anticipatory decision-making. The three consequences were: respect for autonomy, satisfaction with the decision-making process, and improvement in the quality of care. ACP is characterized by anticipatory decision-making regarding the risks faced by patients. In addition, in the event of a sudden “turn for the worse,” necessary life-saving treatment is guaranteed, and the patient documents their wishes for treatment as well as anxieties and fears that help a medical professional or surrogate decision-maker to select life-prolonging treatment in the event of a complication. Conclusions ACP focuses on the quality of life and care rather than determining end-of-life care. The development of this concept contributes to an assessment of the usefulness of ACP support, which can lead to improved approaches to help patients recover over a short period.