Evaluation of a Novel Educational Intervention to Improve Conversations About Implantable Cardioverter-Defibrillators Management in Patients with Advanced Heart Failure. Academic Article uri icon

Overview

abstract

  • Background: Implantable cardioverter-defibrillators (ICDs) reduce the incidence of sudden cardiac death for high-risk patients with heart failure (HF), but shocks from these devices can also cause pain and anxiety at the end of life. Although professional society recommendations encourage proactive discussions about ICD deactivation, clinicians lack training in conducting these conversations, and they occur infrequently. Methods: As part of a six-center randomized controlled trial, we evaluated the educational component of a multicomponent intervention shown to increase conversations about ICD deactivation by clinicians who care for a subset of patients with advanced HF. This consisted of a 90-minute training workshop designed to improve the quality and frequency of conversations about ICD management. To characterize its utility as an isolated intervention, we compared HF clinicians' pre- and postworkshop scores (on a 5-point Likert scale) assessing self-reported confidence and skills in specific practices of advance care planning, ICD deactivation discussions, and empathic communication. Results: Forty intervention-group HF clinicians completed both pre- and postworkshop surveys. Preworkshop scores showed high baseline levels of confidence (4.36, standard deviation [SD] = 0.70) and skill (4.08, SD = 0.72), whereas comparisons of pre- and postworkshop scores showed nonsignificant decreases in confidence (-1.16, p = 0.252) and skill (-0.20, p = 0.843) after the training session. Conclusions: Our findings showed no significant changes in self-assessment ratings immediately after the educational intervention. However, our data did demonstrate that HF clinicians had high baseline self-perceptions of their skills in advance care planning conversations and appear to be well-primed for further professional development to improve communication in the setting of advanced HF.

authors

  • Kwok, Ian
  • Mather, Harriet
  • McKendrick, Karen
  • Gelfman, Laura
  • Hutchinson, Mathew D
  • Lampert, Rachel J
  • Lipman, Hannah I
  • Matlock, Daniel D
  • Swetz, Keith M
  • Kalman, Jill
  • Pinney, Sean
  • Morrison, R Sean
  • Goldstein, Nathan E

publication date

  • June 29, 2020

Research

keywords

  • Advance Care Planning
  • Defibrillators, Implantable
  • Heart Failure

Identity

PubMed Central ID

  • PMC7698841

Scopus Document Identifier

  • 85097868039

Digital Object Identifier (DOI)

  • 10.1089/jpm.2020.0022

PubMed ID

  • 32609036

Additional Document Info

volume

  • 23

issue

  • 12