Feasibility of a Patient Decision Aid for Advance Care Planning Among Adults With a History of Intensive Care Admission: A Pilot Randomized Trial

This pilot randomized controlled trial investigated whether a patient decision aid (PtDA) could enhance preparedness for advance care planning (ACP) among participants treated in the intensive care unit (ICU) following surgery. Participants were recruited online through a private research company in Japan. The intervention group received a researcher-developed PtDA aligned with international standards, while the control group received an informational pamphlet. The SURE test, a screening tool for decisional conflict, was used as the primary outcome to assess confidence in health-related decision-making. A post-intervention web-based survey was also conducted to assess participants’ preferences for ACP support from healthcare professionals. The proportion of participants unable to make an ACP decision was significantly lower in the intervention group ( P < .05); more participants scored 4 on the SURE test, indicating full decisional confidence ( P < .05). Participants expressed needs for healthcare professional presence and psychological support during ACP discussions with families. These findings suggest that a PtDA may effectively enhance decision-making about ACP among ICU survivors, even outside clinical settings, and highlight its potential as a scalable tool supporting post-discharge ACP in community-based contexts.