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Patient and professional factors that impact the perceived likelihood and confidence of healthcare professionals to discuss implantable cardioverter defibrillator deactivation in advanced heart failure: results from an international factorial survey
Hill, Loreena McIlfatrick, Sonja Taylor, Brian J. Jaarsma, Tiny Moser, Debra Slater, Paul McAloon, Toni Dixon, Lana Donnelly, Patrick Stromberg, Anna
Hill, Loreena
McIlfatrick, Sonja
Taylor, Brian J.
Jaarsma, Tiny
Moser, Debra
Slater, Paul
McAloon, Toni
Dixon, Lana
Donnelly, Patrick
Stromberg, Anna
Abstract
Background:
Rate of implantable cardioverter defibrillator (ICD) implantations is increasing in patients with advanced heart failure. Despite clear guideline recommendations, discussions addressing deactivation occur infrequently.
Aim:
The aim of this article is to explore patient and professional factors that impact perceived likelihood and confidence of healthcare professionals to discuss ICD deactivation.
Methods and Results:
Between 2015 and 2016, an international sample of 262 healthcare professionals (65% nursing, 24% medical) completed an online factorial survey, encompassing a demographic questionnaire and clinical vignettes. Each vignette had 9 randomly manipulated and embedded patient-related factors, considered as independent variables, providing 1572 unique vignettes for analysis. These factors were determined through synthesis of a systematic literature review, a retrospective case note review, and a qualitative exploratory study. Results showed that most healthcare professionals agreed that deactivation discussions should be initiated by a cardiologist (95%, n = 255) or a specialist nurse (81%, n = 215). In terms of experience, 84% of cardiologists (n = 53) but only 30% of nurses (n = 50) had previously been involved in a deactivation decision. Healthcare professionals valued patient involvement in deactivation decisions; however, only 50% (n = 130) actively involved family members. Five of 9 clinical factors were associated with an increased likelihood to discuss deactivation including advanced age, severe heart failure, presence of malignancy, receipt of multiple ICD shocks, and more than 3 hospital admissions during the previous year. Furthermore, nationality and discipline significantly influenced likelihood and confidence in decision making.
Conclusions:
Guidelines recommend that healthcare professionals discuss ICD deactivation; however, practice is suboptimal with multifactorial factors impacting on decision making. The role and responsibility of nurses in discussing deactivation require clarity and improvement.
Keywords
decision making, defibrillators, heart failure, implantable, survey, terminal care
Date
2018
Type
Journal article
Journal
Journal of Cardiovascular Nursing
Book
Volume
33
Issue
6
Page Range
527-535
Article Number
ACU Department
Faculty of Health Sciences
Collections
Relation URI
Source URL
Event URL
Open Access Status
License
File Access
Controlled