Development and content validation of decision aids for advanced care planning support for patients undergoing high-risk surgery

Discussing advanced care planning tends to be complex and difficult for patients. Nonetheless, the subject should be briefed prior to high-risk surgery. Patient decision aids have the potential to facilitate the discussions of advanced care planning. This study aimed to develop and validate such patient decision aids in patients who are scheduled for high-risk surgery. Two patient decision aids were developed based on systematic processes and international standards. Their content quality was evaluated, both by health care providers and patients postoperatively admitted to the intensive care unit in Japan. Survey content included comprehensibility, length and suggested improvements to each patient decision aid, which were assessed via questionnaires, free descriptions and interviews. The patient decision aids considered were accepted by both patients and health care providers. However, there was concern among physicians regarding preoperative anxiety increases observed in patients who used them, suggesting that their clinical implementation may be challenging.