Healthcare Professionals' Perspectives on Implantable Cardioverter Defibrillator Deactivation: A Systematic Review

Donna Fitzsimons, Loreena Hill, Sonja McIlfatrick, Brian Taylor

Research output: Contribution to journalArticle

Abstract

Introduction: In an era of advancing technology and clinical expertise, many dying patients with an Implantable Cardioverter Defibrillators (ICD) experience inappropriate shocks. Professional guidance to improve patient care is urgently needed.Aim: To evaluate the evidence on healthcare professionals’ perspectives on ICD deactivation at end-of-life.Methods: A systematic search of six electronic databases, using key terms identified from a preliminary scoping exercise. Empirical studies, as well as articles recommended by experts and citations, that met the inclusion criteria, were included. Twenty-two articles were selected and assessed for eligibility, resulting in 12 studies reviewed for quality (Hawker et al. 2002). Consensus from the research team was obtained before findings from all 12 studies were synthesised using narrative approach (Popay et al. 2006).Results: Studies included a total of 3535 professionals and representatives from 47 European centres. Majority (n=9) of studies were conducted in United States of America. Three main themes identified, Reluctance to initiate the discussion was found across all clinical practice settings. There was generalized agreement that the discussion should be initiated by a cardiologist, however there was diverse opinion (n=5) on the appropriateness of this discussion during pre-implantation consent process. Routinely, professionals associated the discussion with a Do-Not-Resuscitate order. Ethical and legal concerns were portrayed in most studies (n=7). Professionals agreed deactivation was ethically and legally permissible when the patient was terminally ill. Concerns were highlighted regarding the management of the patient with cognitive impairment. Desire for improved knowledge and guidance was mentioned by nine studies. Professionals not employed within a cardiac specialty requested additional knowledge and skills. Expert guidelines could be used to inform institutional protocols, flexible to meet the needs of individual patients.Conclusion: A paradigm shift in terms of who is responsible for this decision is overdue. A multidisciplinary team approach would encourage nursing staff to play a pivotal role concerning ICD deactivation.
LanguageEnglish
JournalCirculation
Volume136
Issue numberSuppl1
Publication statusPublished - 14 Nov 2017

Fingerprint

Implantable Defibrillators
Delivery of Health Care
Resuscitation Orders
Terminally Ill
Nursing Staff
Shock
Consensus
Patient Care
Databases
Guidelines
Exercise
Technology
Research

Keywords

  • Patient care Defibrillator Palliative care Nursing Physician training

Cite this

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abstract = "Introduction: In an era of advancing technology and clinical expertise, many dying patients with an Implantable Cardioverter Defibrillators (ICD) experience inappropriate shocks. Professional guidance to improve patient care is urgently needed.Aim: To evaluate the evidence on healthcare professionals’ perspectives on ICD deactivation at end-of-life.Methods: A systematic search of six electronic databases, using key terms identified from a preliminary scoping exercise. Empirical studies, as well as articles recommended by experts and citations, that met the inclusion criteria, were included. Twenty-two articles were selected and assessed for eligibility, resulting in 12 studies reviewed for quality (Hawker et al. 2002). Consensus from the research team was obtained before findings from all 12 studies were synthesised using narrative approach (Popay et al. 2006).Results: Studies included a total of 3535 professionals and representatives from 47 European centres. Majority (n=9) of studies were conducted in United States of America. Three main themes identified, Reluctance to initiate the discussion was found across all clinical practice settings. There was generalized agreement that the discussion should be initiated by a cardiologist, however there was diverse opinion (n=5) on the appropriateness of this discussion during pre-implantation consent process. Routinely, professionals associated the discussion with a Do-Not-Resuscitate order. Ethical and legal concerns were portrayed in most studies (n=7). Professionals agreed deactivation was ethically and legally permissible when the patient was terminally ill. Concerns were highlighted regarding the management of the patient with cognitive impairment. Desire for improved knowledge and guidance was mentioned by nine studies. Professionals not employed within a cardiac specialty requested additional knowledge and skills. Expert guidelines could be used to inform institutional protocols, flexible to meet the needs of individual patients.Conclusion: A paradigm shift in terms of who is responsible for this decision is overdue. A multidisciplinary team approach would encourage nursing staff to play a pivotal role concerning ICD deactivation.",
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Healthcare Professionals' Perspectives on Implantable Cardioverter Defibrillator Deactivation: A Systematic Review. / Fitzsimons, Donna; Hill, Loreena; McIlfatrick, Sonja; Taylor, Brian.

In: Circulation, Vol. 136, No. Suppl1, 14.11.2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Healthcare Professionals' Perspectives on Implantable Cardioverter Defibrillator Deactivation: A Systematic Review

AU - Fitzsimons, Donna

AU - Hill, Loreena

AU - McIlfatrick, Sonja

AU - Taylor, Brian

PY - 2017/11/14

Y1 - 2017/11/14

N2 - Introduction: In an era of advancing technology and clinical expertise, many dying patients with an Implantable Cardioverter Defibrillators (ICD) experience inappropriate shocks. Professional guidance to improve patient care is urgently needed.Aim: To evaluate the evidence on healthcare professionals’ perspectives on ICD deactivation at end-of-life.Methods: A systematic search of six electronic databases, using key terms identified from a preliminary scoping exercise. Empirical studies, as well as articles recommended by experts and citations, that met the inclusion criteria, were included. Twenty-two articles were selected and assessed for eligibility, resulting in 12 studies reviewed for quality (Hawker et al. 2002). Consensus from the research team was obtained before findings from all 12 studies were synthesised using narrative approach (Popay et al. 2006).Results: Studies included a total of 3535 professionals and representatives from 47 European centres. Majority (n=9) of studies were conducted in United States of America. Three main themes identified, Reluctance to initiate the discussion was found across all clinical practice settings. There was generalized agreement that the discussion should be initiated by a cardiologist, however there was diverse opinion (n=5) on the appropriateness of this discussion during pre-implantation consent process. Routinely, professionals associated the discussion with a Do-Not-Resuscitate order. Ethical and legal concerns were portrayed in most studies (n=7). Professionals agreed deactivation was ethically and legally permissible when the patient was terminally ill. Concerns were highlighted regarding the management of the patient with cognitive impairment. Desire for improved knowledge and guidance was mentioned by nine studies. Professionals not employed within a cardiac specialty requested additional knowledge and skills. Expert guidelines could be used to inform institutional protocols, flexible to meet the needs of individual patients.Conclusion: A paradigm shift in terms of who is responsible for this decision is overdue. A multidisciplinary team approach would encourage nursing staff to play a pivotal role concerning ICD deactivation.

AB - Introduction: In an era of advancing technology and clinical expertise, many dying patients with an Implantable Cardioverter Defibrillators (ICD) experience inappropriate shocks. Professional guidance to improve patient care is urgently needed.Aim: To evaluate the evidence on healthcare professionals’ perspectives on ICD deactivation at end-of-life.Methods: A systematic search of six electronic databases, using key terms identified from a preliminary scoping exercise. Empirical studies, as well as articles recommended by experts and citations, that met the inclusion criteria, were included. Twenty-two articles were selected and assessed for eligibility, resulting in 12 studies reviewed for quality (Hawker et al. 2002). Consensus from the research team was obtained before findings from all 12 studies were synthesised using narrative approach (Popay et al. 2006).Results: Studies included a total of 3535 professionals and representatives from 47 European centres. Majority (n=9) of studies were conducted in United States of America. Three main themes identified, Reluctance to initiate the discussion was found across all clinical practice settings. There was generalized agreement that the discussion should be initiated by a cardiologist, however there was diverse opinion (n=5) on the appropriateness of this discussion during pre-implantation consent process. Routinely, professionals associated the discussion with a Do-Not-Resuscitate order. Ethical and legal concerns were portrayed in most studies (n=7). Professionals agreed deactivation was ethically and legally permissible when the patient was terminally ill. Concerns were highlighted regarding the management of the patient with cognitive impairment. Desire for improved knowledge and guidance was mentioned by nine studies. Professionals not employed within a cardiac specialty requested additional knowledge and skills. Expert guidelines could be used to inform institutional protocols, flexible to meet the needs of individual patients.Conclusion: A paradigm shift in terms of who is responsible for this decision is overdue. A multidisciplinary team approach would encourage nursing staff to play a pivotal role concerning ICD deactivation.

KW - Patient care Defibrillator Palliative care Nursing Physician training

M3 - Article

VL - 136

JO - Circulation

T2 - Circulation

JF - Circulation

SN - 0009-7322

IS - Suppl1

ER -