Cargando…
Characteristics of Clinicians Are Associated With Their Beliefs About ICD Deactivation: Insight From the DECIDE-HF Study
BACKGROUND: Discussing goals of care with heart failure patients is recommended but is not done systematically, due to factors such as time and personal beliefs. A recent survey showed that one-fifth of clinicians believe that implantable cardioverter defibrillator deactivation (ICDD) is unethical o...
Autores principales: | , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8413241/ https://www.ncbi.nlm.nih.gov/pubmed/34505038 http://dx.doi.org/10.1016/j.cjco.2021.03.006 |
_version_ | 1783747620387160064 |
---|---|
author | Landry-Hould, Florence Mondésert, Blandine Day, Andrew G. Ross, Heather J. Brouillette, Judith Clarke, Brian Zieroth, Shelley Toma, Mustafa Parent, Marie-Claude Fowler, Robert A. You, John J. Ducharme, Anique |
author_facet | Landry-Hould, Florence Mondésert, Blandine Day, Andrew G. Ross, Heather J. Brouillette, Judith Clarke, Brian Zieroth, Shelley Toma, Mustafa Parent, Marie-Claude Fowler, Robert A. You, John J. Ducharme, Anique |
author_sort | Landry-Hould, Florence |
collection | PubMed |
description | BACKGROUND: Discussing goals of care with heart failure patients is recommended but is not done systematically, due to factors such as time and personal beliefs. A recent survey showed that one-fifth of clinicians believe that implantable cardioverter defibrillator deactivation (ICDD) is unethical or constitutes physician-assisted suicide. We investigated whether individuals’ characteristics are associated with these beliefs. METHODS: The Decision-Making About Goals of Care for Hospitalized Patients With Heart Failure (DECIDE-HF) survey was given to healthcare providers at 9 hospitals to assess their perceived barriers to goals-of-care discussions. The association between respondent characteristics and their beliefs was examined using 2 adjusted logistic regression models. RESULTS: We included 760 clinicians (459 nurses, 94 fellows, and 207 cardiologists). The responses varied among professions, with the belief that ICDD is unethical considered to be important barrier by nurses (24%), fellows (10%), and staff (7%); P < 0.001). After adjusting for site, spirituality being more important in life (odds ratio [OR]: 2.21; 95% confidence interval [CI]:1.37-3.56; P = 0.001, compared to less important), region of training (Asia [OR: 5.88; 95% CI: 2.12-16.31; P = 0.001] and Middle East [OR: 5.55; 95% CI:1.57-19.63; P = 0.008] compared to Canada), and years in practice (OR: 1.32; 95% CI: 1.07-1.63; P = 0.01 per decade) influenced beliefs about ICDD being unethical, with similar results for the belief that ICDD represents physician-assisted suicide. CONCLUSIONS: Sociocultural factors, region of training, and profession influence clinicians’ beliefs about ICDD being unethical and representing physician-assisted suicide. These factors and beliefs must be acknowledged when facing the delicate issue of end-of-life discussion. |
format | Online Article Text |
id | pubmed-8413241 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-84132412021-09-08 Characteristics of Clinicians Are Associated With Their Beliefs About ICD Deactivation: Insight From the DECIDE-HF Study Landry-Hould, Florence Mondésert, Blandine Day, Andrew G. Ross, Heather J. Brouillette, Judith Clarke, Brian Zieroth, Shelley Toma, Mustafa Parent, Marie-Claude Fowler, Robert A. You, John J. Ducharme, Anique CJC Open Original Article BACKGROUND: Discussing goals of care with heart failure patients is recommended but is not done systematically, due to factors such as time and personal beliefs. A recent survey showed that one-fifth of clinicians believe that implantable cardioverter defibrillator deactivation (ICDD) is unethical or constitutes physician-assisted suicide. We investigated whether individuals’ characteristics are associated with these beliefs. METHODS: The Decision-Making About Goals of Care for Hospitalized Patients With Heart Failure (DECIDE-HF) survey was given to healthcare providers at 9 hospitals to assess their perceived barriers to goals-of-care discussions. The association between respondent characteristics and their beliefs was examined using 2 adjusted logistic regression models. RESULTS: We included 760 clinicians (459 nurses, 94 fellows, and 207 cardiologists). The responses varied among professions, with the belief that ICDD is unethical considered to be important barrier by nurses (24%), fellows (10%), and staff (7%); P < 0.001). After adjusting for site, spirituality being more important in life (odds ratio [OR]: 2.21; 95% confidence interval [CI]:1.37-3.56; P = 0.001, compared to less important), region of training (Asia [OR: 5.88; 95% CI: 2.12-16.31; P = 0.001] and Middle East [OR: 5.55; 95% CI:1.57-19.63; P = 0.008] compared to Canada), and years in practice (OR: 1.32; 95% CI: 1.07-1.63; P = 0.01 per decade) influenced beliefs about ICDD being unethical, with similar results for the belief that ICDD represents physician-assisted suicide. CONCLUSIONS: Sociocultural factors, region of training, and profession influence clinicians’ beliefs about ICDD being unethical and representing physician-assisted suicide. These factors and beliefs must be acknowledged when facing the delicate issue of end-of-life discussion. Elsevier 2021-08-08 /pmc/articles/PMC8413241/ /pubmed/34505038 http://dx.doi.org/10.1016/j.cjco.2021.03.006 Text en © 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Original Article Landry-Hould, Florence Mondésert, Blandine Day, Andrew G. Ross, Heather J. Brouillette, Judith Clarke, Brian Zieroth, Shelley Toma, Mustafa Parent, Marie-Claude Fowler, Robert A. You, John J. Ducharme, Anique Characteristics of Clinicians Are Associated With Their Beliefs About ICD Deactivation: Insight From the DECIDE-HF Study |
title | Characteristics of Clinicians Are Associated With Their Beliefs About ICD Deactivation: Insight From the DECIDE-HF Study |
title_full | Characteristics of Clinicians Are Associated With Their Beliefs About ICD Deactivation: Insight From the DECIDE-HF Study |
title_fullStr | Characteristics of Clinicians Are Associated With Their Beliefs About ICD Deactivation: Insight From the DECIDE-HF Study |
title_full_unstemmed | Characteristics of Clinicians Are Associated With Their Beliefs About ICD Deactivation: Insight From the DECIDE-HF Study |
title_short | Characteristics of Clinicians Are Associated With Their Beliefs About ICD Deactivation: Insight From the DECIDE-HF Study |
title_sort | characteristics of clinicians are associated with their beliefs about icd deactivation: insight from the decide-hf study |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8413241/ https://www.ncbi.nlm.nih.gov/pubmed/34505038 http://dx.doi.org/10.1016/j.cjco.2021.03.006 |
work_keys_str_mv | AT landryhouldflorence characteristicsofcliniciansareassociatedwiththeirbeliefsabouticddeactivationinsightfromthedecidehfstudy AT mondesertblandine characteristicsofcliniciansareassociatedwiththeirbeliefsabouticddeactivationinsightfromthedecidehfstudy AT dayandrewg characteristicsofcliniciansareassociatedwiththeirbeliefsabouticddeactivationinsightfromthedecidehfstudy AT rossheatherj characteristicsofcliniciansareassociatedwiththeirbeliefsabouticddeactivationinsightfromthedecidehfstudy AT brouillettejudith characteristicsofcliniciansareassociatedwiththeirbeliefsabouticddeactivationinsightfromthedecidehfstudy AT clarkebrian characteristicsofcliniciansareassociatedwiththeirbeliefsabouticddeactivationinsightfromthedecidehfstudy AT zierothshelley characteristicsofcliniciansareassociatedwiththeirbeliefsabouticddeactivationinsightfromthedecidehfstudy AT tomamustafa characteristicsofcliniciansareassociatedwiththeirbeliefsabouticddeactivationinsightfromthedecidehfstudy AT parentmarieclaude characteristicsofcliniciansareassociatedwiththeirbeliefsabouticddeactivationinsightfromthedecidehfstudy AT fowlerroberta characteristicsofcliniciansareassociatedwiththeirbeliefsabouticddeactivationinsightfromthedecidehfstudy AT youjohnj characteristicsofcliniciansareassociatedwiththeirbeliefsabouticddeactivationinsightfromthedecidehfstudy AT ducharmeanique characteristicsofcliniciansareassociatedwiththeirbeliefsabouticddeactivationinsightfromthedecidehfstudy AT characteristicsofcliniciansareassociatedwiththeirbeliefsabouticddeactivationinsightfromthedecidehfstudy |