Shocked: Confronting The Decision To Accept Or Decline An Implantable Cardioverter Defibrillator (ICD)

Background And Aim: Primary cardiac rhythm management device (CRMD) provides potentially lifesaving treatment for people at risk of sudden cardiac death. Yet the enormity and uncertainty of benefits and harms present challenges for patient decision-making surrounding device implantation. There was limited international and no UK based research related to the process and influences affecting patient CRMD decision-making. The aim of this research was to explore ‘what influences adult patients' decision-making in accepting or declining primary prevention complex cardiac rhythm management devices?’ Research Methods And Analysis: A scoping review, followed by a four step, mixed methods, concurrent research design, with three strands was employed. Strand one involved completion of a structured questionnaire, administered to a convenient sample of 50 patients, across 4 implant sites. Strand two entailed concurrent semi-structured interviews with a purposive sample of 17 patients who had accepted, and 3 who had declined a cardiac device. A range of statistical testing was applied to the Strand 1 data using IBM SPSS statistical software v25. Framework analysis was used to analyse the Strand 2 narrative data. The data sets were merged and integrated into Strand 3. Findings: A novel theoretical model of patient decision-making for primary CRMD was developed. Four types of decision-making emerged in response to a recommendation for CRMD. They are Leap Of Faith, Reinforced Acceptance, Reinforced Refusal or Reconsideration. Certain socio-demographic and situational factors appeared to predict and influence the type of decision-making. The level and accuracy of knowledge acquisition, information recall and informed consent characterised the alternate decision-making journeys. Conclusion: An appreciation of the type of decision-making may inform the development of a framework of tailored information and communication to enable effective decision making, to meet specific needs and situations, to facilitate truly informed choices, and help acceptance and adjustment to life with this significant technology

Non-pharmacological interventions to reduce psychological distress in patients undergoing diagnostic cardiac catheterization: a rapid review

Abstract Background: Cardiac catheterization is the standard procedure for the diagnosis of coronary heart disease. The threat physically and emotionally from this procedure can effect the patient’s perception of their health. The heightened psychological distress associated with this diagnostic procedure can cause adverse patient outcomes. Non-pharmacologic interventions have been implemented to reduce psychological distress associated with cardiac catheterization. Aims: The objective of this rapid review is to assess the efficacy of non-pharmacologic interventions (procedural education, relaxation techniques, psychological preparation) on psychological distress experienced by patients as they undergo a cardiac catheterization. Methods: Published, peer-reviewed, English-language intervention studies from 1981 to 2014 were identified in a search of CINAHL, Medline, and Cochrane Library. Eligible studies included adults undergoing cardiac catheterization. Studies included in this review used experimental and quasi-experimental designs and assessed at least one primary outcome: anxiety, depression, and pain to test non-pharmacologic interventions pre and post-cardiac catheterization. Researchers independently extracted data from included studies and completed a quality assessment using a published tool. Data was synthesised as a narrative. Results: There were 29 eligible experimental and quasi-experimental studies that tested the 3 interventions (n=2504). Findings suggest that non-pharmacologic interventions were able to effectively reduce psychological distress in some patients undergoing cardiac catheterization. Conclusion: Evidence is stronger in recent studies that non-pharmacologic interventions of procedural education and psychological preparation can reduce psychological distress in patients undergoing cardiac catheterization. Further research is needed to define the various relaxation techniques that can be effectively implemented for patients undergoing cardiac catheterization

Adult Patient Decision-making Regarding Implantation Of Complex Cardiac Devices: A Scoping Review

Background: Complex cardiac rhythm management device (CRMD) therapy provides an important treatment option for people at risk of sudden cardiac death (SCD). Despite the survival benefit, device implantation is associated with significant physical and psychosocial concerns presenting considerable challenges for the decision-making process surrounding CRMD implantation for patients and physicians. Aims: The purpose of this scoping review was to explore what is known about how adult (>16 years) patients make decisions regarding implantation of CRMD therapy. Methods: Published, peer-reviewed, English-language studies from 2000 to 2016 were identified in a search across eight healthcare databases. Eligible studies were concerned with patient decision-making for first time device implantation. Quality assessment was completed using the Mixed Methods Appraisal Tool (MMAT) for all studies meeting the inclusion criteria. Results: The findings of 8 qualitative and 7 quantitative studies, including patients who accepted or declined primary or secondary SCD prevention devices, were clustered in to two themes; knowledge acquisition and the process of decision-making, exposing similarities and distinctions with the treatment decision-making literature. Conclusion: The review revealed some insight in to the way patients approach decision-making but also exposed a lack of clarity and research activity specific to CRMD patients. Further research is recommended to support the development and application of targeted decision support mechanisms