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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

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 f...

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Autores principales: Hill, Loreena, McIlfatrick, Sonja, Taylor, Brian J., Jaarsma, Tiny, Moser, Debra, Slater, Paul, McAloon, Toni, Dixon, Lana, Donnelly, Patrick, Stromberg, Anna, Fitzsimons, Donna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6200367/
https://www.ncbi.nlm.nih.gov/pubmed/29727378
http://dx.doi.org/10.1097/JCN.0000000000000500
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author Hill, Loreena
McIlfatrick, Sonja
Taylor, Brian J.
Jaarsma, Tiny
Moser, Debra
Slater, Paul
McAloon, Toni
Dixon, Lana
Donnelly, Patrick
Stromberg, Anna
Fitzsimons, Donna
author_facet Hill, Loreena
McIlfatrick, Sonja
Taylor, Brian J.
Jaarsma, Tiny
Moser, Debra
Slater, Paul
McAloon, Toni
Dixon, Lana
Donnelly, Patrick
Stromberg, Anna
Fitzsimons, Donna
author_sort Hill, Loreena
collection PubMed
description 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.
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spelling pubmed-62003672018-11-21 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 Fitzsimons, Donna J Cardiovasc Nurs ARTICLES: Heart Failure 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. Lippincott Williams & Wilkins 2018 2018-04-26 /pmc/articles/PMC6200367/ /pubmed/29727378 http://dx.doi.org/10.1097/JCN.0000000000000500 Text en Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle ARTICLES: Heart Failure
Hill, Loreena
McIlfatrick, Sonja
Taylor, Brian J.
Jaarsma, Tiny
Moser, Debra
Slater, Paul
McAloon, Toni
Dixon, Lana
Donnelly, Patrick
Stromberg, Anna
Fitzsimons, Donna
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
title 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_short 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
title_sort 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
topic ARTICLES: Heart Failure
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6200367/
https://www.ncbi.nlm.nih.gov/pubmed/29727378
http://dx.doi.org/10.1097/JCN.0000000000000500
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