P039 Introducing Advance Care Planning Prior to High-Risk Operations: A Pilot Project in the Cardiovascular Surgery Department

Advance care planning (ACP) is the process of identifying a substitute decision maker and examining personal values that influence healthcare wishes. This practice is especially important for high-risk surgical patients but is not yet a routine aspect of pre-operative care. The purpose of this pilot project was to assess the feasibility of implementing an advance care planning intervention with patients prior to cardiovascular surgery. This included identifying potential barriers and facilitators within the setting and gaining an understanding of the patient experience with ACP. An oversight committee of key stakeholders identified the current advance care planning practices in cardiac surgery. The patient trajectory was mapped and specific instances were targeted for ACP intervention. Institutionally approved ACP documentation was reviewed to develop an educational intervention. Patients were provided ACP information pre-operatively and were visited after surgery. Follow-up visits explored patient and family perceptions of advance care planning, completion and documentation of ACPs, and barriers and facilitators of incorporating ACP into the surgical process. At the midpoint, 20 patients had been interviewed. Of those 20, 2 (10%) had received the ACP documents at the pre-operative visit with the surgeon and 15 (75%) patients at the pre-admission visit. 13 (65%) patients identified a Power of Attorney (POA) and 10 (50%) had this documented. 6 (30%) stated they had some type of advance care directive; none of the advance care directives were documented. Overall it is feasible to provide an ACP intervention before major surgery and patients were satisfied with the information received. Patient-reported barriers included receiving too much information before surgery and feeling anxious discussing ACP. Framing ACP as a routine component of the surgical preparation process facilitated this practice. Two potential targets for further intervention may be the pre-operative surgical visit and the pre-admission clinic visit.