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Patient and Profess...
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
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- Hill, Loreena (author)
- Queens Univ, North Ireland
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- McIlfatrick, Sonja (author)
- Ulster Univ, North Ireland; All Ireland Inst Hosp and Palliat Care, Ireland
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- Taylor, Brian J. (author)
- Ulster Univ, North Ireland
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- Jaarsma, Tiny (author)
- Linköpings universitet,Avdelningen för omvårdnad,Medicinska fakulteten,Mary MacKillop Inst Hlth Res, Australia
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- Moser, Debra (author)
- Univ Kentucky, KY USA; Univ Kentucky, KY USA
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- Slater, Paul (author)
- Ulster Univ, North Ireland
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- McAloon, Toni (author)
- Ulster Univ, North Ireland
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- Dixon, Lana (author)
- Belfast Hlth and Social Care Trust, North Ireland
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- Donnelly, Patrick (author)
- South Eastern Hlth and Social Care Trust, North Ireland
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- Strömberg, Anna (author)
- Linköpings universitet,Avdelningen för omvårdnad,Medicinska fakulteten,Region Östergötland, Kardiologiska kliniken US
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- Fitzsimons, Donna (author)
- Queens Univ, North Ireland; All Ireland Inst Hosp and Palliat Care, Ireland
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(creator_code:org_t)
- LIPPINCOTT WILLIAMS & WILKINS, 2018
- 2018
- English.
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In: Journal of Cardiovascular Nursing. - : LIPPINCOTT WILLIAMS & WILKINS. - 0889-4655 .- 1550-5049. ; 33:6, s. 527-535
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https://liu.diva-por... (primary) (Raw object)
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
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- 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.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskap -- Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Health Sciences -- Health Care Service and Management, Health Policy and Services and Health Economy (hsv//eng)
Keyword
- decision making; defibrillators; heart failure; implantable; survey; terminal care
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Hill, Loreena
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McIlfatrick, Son ...
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Taylor, Brian J.
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Jaarsma, Tiny
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Moser, Debra
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Slater, Paul
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show more...
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McAloon, Toni
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Dixon, Lana
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Donnelly, Patric ...
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Strömberg, Anna
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Fitzsimons, Donn ...
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show less...
- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Health Sciences
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and Health Care Serv ...
- Articles in the publication
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Journal of Cardi ...
- By the university
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Linköping University