Perioperative advance care planning for supporting decision-making in elderly patients: a retrospective study and questionnaire survey at a single center

Background; In high-risk elderly patients with severe comorbidities, perioperative advance care planning (ACP) should go beyond informed consent/shared decision-making (SDM), and should address difficult decision-making. We examined perioperative ACP in elderly patients in an acute care hospital, including the types of decision-making support provided by healthcare professionals. Methods; Between June and October 2024, retrospective ACP data for inpatients during the perioperative period were collected and conceptually analyzed based on five dimensions: prognosis, intentions regarding operation, future goals, family-related issues, and concerns. Next, in June 2025, a scenario-based questionnaire survey regarding elderly patients with liver metastases from gastric cancer was conducted among doctors, nurses, and medical staff at our hospital. Results; Perioperative ACP was conducted in 41 cases, mainly elderly patients, females and those with cardiac disease. While 52% of ACPs patients mentioned life expectancy and 61% mentioned future goals, there was little mention of postoperative progress, long-term prognosis, or surrogate decision makers. Patients occasionally confided in their family members regarding decision makings. Nest as to questionnaire survey, among 749 participants surveyed, 575 responded (76.8% response rate: 149 physicians, 378 nurses, and 48 medical staff). Regarding their opinions about treatment preferences for patients who did not desire aggressive treatment but their family did, the proportion of respondents choosing “chemotherapy” increased, with no significant increase in preference for “operation”. Doctors respected patients' wishes, while nurses respected both patients’ and families’ wishes. Conclusions; This study examined the type of ACP implemented during the perioperative period at our hospital, an acute care hospital for elderly patients. Regarding treatment selection and long-term prognosis based on that selection was still insufficient, suggesting the need for anesthesiologists and surgeons to also implement ACP. When implementing perioperative ACP, it will be important for health care professionals to collaborate with each other and utilize their professional strengths to form multidisciplinary discussions.