Efficacy of Advance Care Planning Support by Decision Aid in Intensive Care Patients: A Pilot Randomized Trial

Abstract

Background Patients treated in the intensive care unit (ICU) may sometimes undergo abrupt transitions to the end of life. In the past, supporting treatment decisions for such patients has been a challenge. Researchers have developed a patient decision aid (PtDAs) to support advance care planning (ACP) in critical care patients during the perioperative period. Clinical feasibility studies showed that patient PtDAs can be implemented clinically. A pilot randomized trial was conducted to evaluate the PtDA’s clinical diffusion and efficacy. Methods The PtDAsintervention was developed according to international standards. This study used an online panel from a private Japanese research company. Participants completed surveys in March and April 2023. The patients were treated in the intensive care unit after surgery. The control group was provided with a pamphlet explaining the ACP procedure, and the intervention group was provided with a decision aid. The measures used in the study included the SURE test, which assesses the quality of decision-making, understanding of life-sustaining treatments, and the need to arrange ACP. The survey was conducted from March–April 2023. Results The intervention group had a significantly higher quality of decision-making regarding life-sustaining treatment than the control group (p< .05). However, there was no difference in their understanding of life-sustaining treatments. Both groups were aware of the need for further medical explanations regarding the treatment details related to assisted circulation devices and dialysis in the ICU. The participants had to be witnessed by a medical provider when discussing ACP with a surrogate decision-maker. Additionally, there is a need for mental support from surrogate decision-makers and families following ACP discussions. Conclusions Decision-aided ACP support can help patients undergoing intensive care after surgery make satisfactory decisions. In this case, the inclusion of counseling and coaching by the medical provider might facilitate the sharing of thoughts and feelings between the patient and the surrogate decision-maker. Discussing desires regarding ACP between the patient and surrogate decision-maker can reduce the burden on the surrogate decision-maker when life-sustaining treatment decisions must be made.