Shared Decision-Making about End-of-Life Care Scenarios Compared among Implantable Cardioverter Defibrillator Patients: A National Cohort Study

Thompson, JH; Thylén, I; Moser, DK

Shared Decision-Making about End-of-Life Care Scenarios Compared among Implantable Cardioverter Defibrillator Patients: A National Cohort Study

Thompson, JH Thylén, I Moser, DK

Permalink

Publication Type:: Journal Article
Citation:: Circulation: Heart Failure, 2019, 12 (10)
Issue Date:: 2019-10-01

Closed Access

	Filename	Description	Size
	Shared Decision-Making About End-of-Life Care Scenarios Compared Among Implantable Cardioverter Defibrillator Patients A National Cohort Study..pdf	Published Version	50.83 kB	Adobe PDF	View/Open

Copyright Clearance Process

Recently Added
In Progress
Closed Access

This item is closed access and not available.

Full metadata record

Field	Value	Language
dc.contributor.author	Thompson, JH	en_US
dc.contributor.author	Thylén, I	en_US
dc.contributor.author	Moser, DK	en_US
dc.date.accessioned	2020-04-20T04:53:24Z
dc.date.available	2020-04-20T04:53:24Z
dc.date.issued	2019-10-01	en_US
dc.identifier.citation	Circulation: Heart Failure, 2019, 12 (10)	en_US
dc.identifier.issn	1941-3289	en_US
dc.identifier.uri	http://hdl.handle.net/10453/140111
dc.description.abstract	© 2019 American Heart Association, Inc. Background: Authors of expert guidelines and consensus statements recommend that decisions at the end-of-life (EOL) be discussed before and after implantation of an implantable cardioverter defibrillator (ICD) and include promotion of shared decision-making. The purpose of this study was to describe experiences, attitudes, and knowledge about the ICD at EOL in ICD recipients and to compare experiences, attitudes, and knowledge in ICD recipients with and without heart failure (HF). We further sought to determine factors associated with having discussions about EOL. Methods and Results: Using a national registry in Sweden of all ICD recipients (n=5355) in 2012, an EOL questionnaire, along with other ICD-related measures, was completed by 2403 ICD recipients. Of the participants, 1275 (n=53%) had HF. Their responses in the knowledge, experience, and attitude domains were almost identical to those without HF. Forty percent of patients with and without HF did not want to discuss their illness trajectory or deactivation of their ICD ever. In logistic regression analyses, we found that having had an ICD shock (OR, 2.05; CI, 1.64-2.56), having high levels of anxiety (OR, 1.41; CI, 1.04-1.92), and having high levels of ICD concerns (OR, 1.53; CI, 1.22-1.92) were the only significant predictors of having discussions with providers about EOL scenarios (P<0.001 for full model). Conclusions: HF was not a predictor of having an EOL conversation. Further research is needed to determine if attitudes related to not wanting to discuss EOL interfere with good quality of life and of death, or if shared decision-making should be encouraged in these individuals.	en_US
dc.relation.ispartof	Circulation: Heart Failure	en_US
dc.relation.isbasedon	10.1161/CIRCHEARTFAILURE.118.005619	en_US
dc.subject.classification	Cardiovascular System & Hematology	en_US
dc.title	Shared Decision-Making about End-of-Life Care Scenarios Compared among Implantable Cardioverter Defibrillator Patients: A National Cohort Study	en_US
dc.type	Journal Article
utslib.citation.volume	10	en_US
utslib.citation.volume	12	en_US
utslib.for	0601 Biochemistry and Cell Biology	en_US
utslib.for	1102 Cardiorespiratory Medicine and Haematology	en_US
utslib.for	1116 Medical Physiology	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
utslib.copyright.status	closed_access
pubs.issue	10	en_US
pubs.publication-status	Published	en_US
pubs.volume	12	en_US

Abstract:

© 2019 American Heart Association, Inc. Background: Authors of expert guidelines and consensus statements recommend that decisions at the end-of-life (EOL) be discussed before and after implantation of an implantable cardioverter defibrillator (ICD) and include promotion of shared decision-making. The purpose of this study was to describe experiences, attitudes, and knowledge about the ICD at EOL in ICD recipients and to compare experiences, attitudes, and knowledge in ICD recipients with and without heart failure (HF). We further sought to determine factors associated with having discussions about EOL. Methods and Results: Using a national registry in Sweden of all ICD recipients (n=5355) in 2012, an EOL questionnaire, along with other ICD-related measures, was completed by 2403 ICD recipients. Of the participants, 1275 (n=53%) had HF. Their responses in the knowledge, experience, and attitude domains were almost identical to those without HF. Forty percent of patients with and without HF did not want to discuss their illness trajectory or deactivation of their ICD ever. In logistic regression analyses, we found that having had an ICD shock (OR, 2.05; CI, 1.64-2.56), having high levels of anxiety (OR, 1.41; CI, 1.04-1.92), and having high levels of ICD concerns (OR, 1.53; CI, 1.22-1.92) were the only significant predictors of having discussions with providers about EOL scenarios (P<0.001 for full model). Conclusions: HF was not a predictor of having an EOL conversation. Further research is needed to determine if attitudes related to not wanting to discuss EOL interfere with good quality of life and of death, or if shared decision-making should be encouraged in these individuals.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/140111