Recent studies report that since the late 1990s mortality rates have declined among patients who undergo high-risk surgery procedures in the United States, despite increases in the number of operations performed. Findings will inform the next stages of developing the first advance care planning decision aid for high-risk surgery patients. Stakeholders supported incorporating advance care planning in high-risk surgical settings and endorsed the appropriateness of using decision aids to do so. A recipe emerged from the data that outlines tools, ingredients, and tips for success that are needed to design an advance care planning decision aid for high-risk surgical settings. In general, decision aids were viewed as an appropriate approach to support advance care planning for this population. Key informants described the importance of initiating advance care planning preoperatively, despite potential challenges present in surgical settings. Researchers took de-identified notes that were analyzed for emerging concordant, discordant, and recurrent themes using interpretative phenomenological analysis. Key informants were asked to discuss their thoughts about advance care planning and interventions to support advance care planning, particularly for this population. Semi-structured interviews were conducted by phone until data collected reached theoretical saturation. Key informants were recruited through purposive and snowball sampling. This study sought to examine stakeholders’ views on the appropriateness of using decision aids, in general, to support advance care planning among high-risk surgery populations and the design of such a decision aid. Advance care planning prior to surgery may be beneficial, but remains controversial and is hindered by a lack of appropriate decision aids. High-risk surgery patients may lose decision-making capacity as a result of surgical complications.
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