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

The aim of this research was to clarify the concept of advance care planning (ACP) for patients undergoing high-risk surgery. The Walker & Avant’s approach to concept analysis was used. ACP for the patient who received a high-risk surgery was defined as follows: patients who are aware of the risks of surgery are initiated voluntarily with the need to participate in anticipatory decision-making. To do this, patients define their life-prolonging treatment, provided that appropriate treatment is guaranteed, and prepare for end-of-life care decisions through discussions involving healthcare providers and surrogate decision-makers. It is a continuous, patient-centered decision that allows the patient’s treatment goals to transition over time. The goal of the ACP is to focus on quality of life and care rather than determining end-of-life care. The development of this concept contributes to an assessment of the value of ACP support, which can lead to improved approaches to help patients recover in a short period. Plain Language Summary Many patients undergoing high-risk surgery receive critical care after surgery, yet there is a risk of the patient taking a sudden turn for the worse. Patients can opt to preplan their treatment preferences in preparation for potential complications or adverse outcomes. The aim of this research was to clarify the concept of advance care planning (ACP) for patients undergoing high-risk surgery. The method of 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. Five attributes of this concept were extracted: promise of proper treatment, the 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: recognition of expected risks and the need for anticipatory decision-making. The three conclusions were: respect for autonomy, satisfaction with the decision-making process, and improvement in the quality of care. ACP is characterized by anticipatory decision-making about 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 has informed about wishes for treatment as well as anxieties and fears that help a medical professional or surrogate decision-maker to select