Patient and Professional factors that impact the perceived likelihood and confidence of healthcare professionals to discuss Implantable Cardioverter Defibrillators (ICDs) deactivation in advanced heart failure: Results from an International Factorial Survey

L Hill, S McIlfatrick, Brian Taylor, T Jaarsma, D Moser, P Slater, T McAloon, L Dixon, P Donnelly, A Stromberg, D Fitzsimons

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1 Citation (Scopus)

Abstract

Background: Rate of ICD implantations is increasing in patients with advanced heart failure. Despite clear guideline recommendation, discussions addressing deactivation occur infrequently. Aim: 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 demographic questionnaire and clinical vignettes. Each vignette had nine randomly manipulated and embedded patient-related factors, considered as independent variables, providing 1,572 unique vignettes for analysis. These factors were determined through synthesis of a systematic literature review, retrospective case note review and qualitative exploratory study. Results showed most healthcare professionals agreed deactivation discussions should be initiated by a cardiologist (95%, n=255) or specialist nurse (81%, n=215). In terms of experience, 84% (n=53) of cardiologists but only 30% (n=50) of nurses 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 out of nine 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 three hospital admissions during the previous year. Furthermore, nationality and discipline significantly influenced likelihood and confidence in decision-making. Conclusions: Guidelines recommend healthcare professionals discuss ICD deactivation, however practise is sub-optimal with multifactorial factors impacting on decision-making. The role and responsibility of nurses in discussing deactivation requires clarity and improvement.
LanguageEnglish
Pages527-535
Number of pages9
JournalJournal of Cardiovascular Nursing
Volume33
Issue number6
Early online date30 Apr 2018
DOIs
Publication statusPublished - 1 Dec 2018

Fingerprint

Implantable Defibrillators
Heart Failure
Delivery of Health Care
Decision Making
Guidelines
Patient Participation
Nurse's Role
Ethnic Groups
Shock
Nursing
Nurses
Demography
Surveys and Questionnaires
Neoplasms
Cardiologists

Keywords

  • Defibrillators
  • implantable
  • Heart Failure
  • Decision-making
  • Survey
  • Terminal care

Cite this

@article{06a272954bfb4f82a4c72796722052df,
title = "Patient and Professional factors that impact the perceived likelihood and confidence of healthcare professionals to discuss Implantable Cardioverter Defibrillators (ICDs) deactivation in advanced heart failure: Results from an International Factorial Survey",
abstract = "Background: Rate of ICD implantations is increasing in patients with advanced heart failure. Despite clear guideline recommendation, discussions addressing deactivation occur infrequently. Aim: 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 demographic questionnaire and clinical vignettes. Each vignette had nine randomly manipulated and embedded patient-related factors, considered as independent variables, providing 1,572 unique vignettes for analysis. These factors were determined through synthesis of a systematic literature review, retrospective case note review and qualitative exploratory study. Results showed most healthcare professionals agreed deactivation discussions should be initiated by a cardiologist (95{\%}, n=255) or specialist nurse (81{\%}, n=215). In terms of experience, 84{\%} (n=53) of cardiologists but only 30{\%} (n=50) of nurses 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 out of nine 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 three hospital admissions during the previous year. Furthermore, nationality and discipline significantly influenced likelihood and confidence in decision-making. Conclusions: Guidelines recommend healthcare professionals discuss ICD deactivation, however practise is sub-optimal with multifactorial factors impacting on decision-making. The role and responsibility of nurses in discussing deactivation requires clarity and improvement.",
keywords = "Defibrillators, implantable, Heart Failure, Decision-making, Survey, Terminal care",
author = "L Hill and S McIlfatrick and Brian Taylor and T Jaarsma and D Moser and P Slater and T McAloon and L Dixon and P Donnelly and A Stromberg and D Fitzsimons",
note = "A second accepted author manuscript was uploaded at Brian Taylor's request. So the access to the original uploaded manuscript has been set to 'closed'. Brian Taylor noticed a typing error in the title of the author's manuscript so title was fixed and re-uploaded.",
year = "2018",
month = "12",
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doi = "10.1097/JCN.0000000000000500",
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T1 - Patient and Professional factors that impact the perceived likelihood and confidence of healthcare professionals to discuss Implantable Cardioverter Defibrillators (ICDs) deactivation in advanced heart failure: Results from an International Factorial Survey

AU - Hill, L

AU - McIlfatrick, S

AU - Taylor, Brian

AU - Jaarsma, T

AU - Moser, D

AU - Slater, P

AU - McAloon, T

AU - Dixon, L

AU - Donnelly, P

AU - Stromberg, A

AU - Fitzsimons, D

N1 - A second accepted author manuscript was uploaded at Brian Taylor's request. So the access to the original uploaded manuscript has been set to 'closed'. Brian Taylor noticed a typing error in the title of the author's manuscript so title was fixed and re-uploaded.

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Background: Rate of ICD implantations is increasing in patients with advanced heart failure. Despite clear guideline recommendation, discussions addressing deactivation occur infrequently. Aim: 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 demographic questionnaire and clinical vignettes. Each vignette had nine randomly manipulated and embedded patient-related factors, considered as independent variables, providing 1,572 unique vignettes for analysis. These factors were determined through synthesis of a systematic literature review, retrospective case note review and qualitative exploratory study. Results showed most healthcare professionals agreed deactivation discussions should be initiated by a cardiologist (95%, n=255) or specialist nurse (81%, n=215). In terms of experience, 84% (n=53) of cardiologists but only 30% (n=50) of nurses 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 out of nine 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 three hospital admissions during the previous year. Furthermore, nationality and discipline significantly influenced likelihood and confidence in decision-making. Conclusions: Guidelines recommend healthcare professionals discuss ICD deactivation, however practise is sub-optimal with multifactorial factors impacting on decision-making. The role and responsibility of nurses in discussing deactivation requires clarity and improvement.

AB - Background: Rate of ICD implantations is increasing in patients with advanced heart failure. Despite clear guideline recommendation, discussions addressing deactivation occur infrequently. Aim: 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 demographic questionnaire and clinical vignettes. Each vignette had nine randomly manipulated and embedded patient-related factors, considered as independent variables, providing 1,572 unique vignettes for analysis. These factors were determined through synthesis of a systematic literature review, retrospective case note review and qualitative exploratory study. Results showed most healthcare professionals agreed deactivation discussions should be initiated by a cardiologist (95%, n=255) or specialist nurse (81%, n=215). In terms of experience, 84% (n=53) of cardiologists but only 30% (n=50) of nurses 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 out of nine 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 three hospital admissions during the previous year. Furthermore, nationality and discipline significantly influenced likelihood and confidence in decision-making. Conclusions: Guidelines recommend healthcare professionals discuss ICD deactivation, however practise is sub-optimal with multifactorial factors impacting on decision-making. The role and responsibility of nurses in discussing deactivation requires clarity and improvement.

KW - Defibrillators

KW - implantable

KW - Heart Failure

KW - Decision-making

KW - Survey

KW - Terminal care

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DO - 10.1097/JCN.0000000000000500

M3 - Article

VL - 33

SP - 527

EP - 535

JO - Journal of Cardiovascular Nursing

T2 - Journal of Cardiovascular Nursing

JF - Journal of Cardiovascular Nursing

SN - 0889-4655

IS - 6

ER -