Systematic review of decision tools and their suitability for patient-centered decisionmaking regarding electronic cardiac devices
These should address gaps in patient knowledge and issues related to anxiety, social support, and fear of shocks. Decision tools that address insertion should also address the possibility of future deactivation. The information should be accurate, balanced, and address both technical and quality-of-...
| Main Authors: | , , |
|---|---|
| Corporate Authors: | , |
| Format: | eBook |
| Language: | English |
| Published: |
Rockville, Maryland
AHRQ, Technology Assessment Program
May 23, 2012, 2012
|
| Series: | Technology assessment report
|
| Subjects: | |
| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | These should address gaps in patient knowledge and issues related to anxiety, social support, and fear of shocks. Decision tools that address insertion should also address the possibility of future deactivation. The information should be accurate, balanced, and address both technical and quality-of-life dimensions. Development of multidisciplinary support interventions around deactivation should be encouraged Threats to informed consent were patient passivity, lack of information on the implications of deactivation, and the psychosocial disruption caused by devices, notably the shocks from ICDs. Limited social support was reported around decisionmaking or psychosocial wellbeing. Both quantitative and qualitative studies showed anxiety in many patients. The main factors associated with anxiety were: shock frequency, Type D (distressed) personality, social and educational status, and age. Communication-related factors that influenced psychosocial outcomes and quality of decisionmaking were the presence or absence of organizational policies around deactivation, lack of training and comfort among health professionals in instigating and maintaining dialogue with patients about deactivation, and discussions that were too near patients' end of life. CONCLUSIONS: Given the absence of well-developed tools, decision tools are urgently needed to address deactivation of ECDs. OBJECTIVES: 1) Identify validated decision aids available for insertion, continuation, or deactivation of electronic cardiac devices (ECDs); 2) Review evidence on the effectiveness of decision aids for promoting informed decisionmaking and their relevance to the Medicare population; 3) Identify barriers to use of decision aids. DATA SOURCES: We systematically searched six electronic databases up to February 2011. We searched extensively for grey literature and contacted experts in the field. METHODS: Two reviewers independently selected studies and assessed quality. One reviewer extracted data, and a second reviewer checked data. We assessed quality of tools using recognized criteria and synthesized findings using meta-ethnographic and integrative approaches. RESULTS: We identified four decisionmaking tools for insertion of implantable cardioverter-defibrillators (ICDs) and pacemakers in patients with heart failure or with or at risk for arrhythmia. No trials evaluating these tools were available. The tools contained adequate information for technical comprehensiveness, but were weak in addressing patient quality of life and presenting neutral information about devices. Deactivation was not addressed in any of the tools. No tools existed for deactivation of any device. We identified 67 studies on barriers to the use of decisions aids in ECD populations: patient experiences (n=33), psychosocial outcomes (n=26), and communication (n=8). Studies focused predominantly on ICDs. Overall study quality was moderate. Patients generally have poor knowledge of key aspects of deactivation, the role of the device, and the impact of deactivating the device on their health. Communication with physicians was often poor, with professionals viewed as over-imposing their own values and priorities. Patients wanted discussions with a range of health professionals. |
|---|---|
| Item Description: | Title from PDF title page. - "Project ID: CRDT0810." |
| Physical Description: | 1 PDF file (various pagings) illustration |