Implantable cardioverter defibrillator knowledge and end-of-life device deactivation

A cross-sectional survey

Samantha M. McEvedy, Jan Cameron, Eugene Lugg, Jennifer Miller, Chris Haedtke, Muna Hammash, Martha J. Biddle, Kyoung Suk Lee, Justin A. Mariani, Chantal F. Ski, David R. Thompson, Misook Lee Chung, Debra K. Moser

Research output: Contribution to journalArticleResearchpeer-review

6 Citations (Scopus)

Abstract

Background: End-of-life implantable cardioverter defibrillator deactivation discussions should commence before device implantation and be ongoing, yet many implantable cardioverter defibrillators remain active in patients’ last days. Aim: To examine associations among implantable cardioverter defibrillator knowledge, patient characteristics and attitudes to implantable cardioverter defibrillator deactivation. Design: Cross-sectional survey using the Experiences, Attitudes and Knowledge of End-of-Life Issues in Implantable Cardioverter Defibrillator Patients Questionnaire. Participants were classified as insufficient or sufficient implantable cardioverter defibrillator knowledge and the two groups were compared. Setting/participants: Implantable cardioverter defibrillator recipients (n = 270, mean age 61 ± 14 years; 73% male) were recruited from cardiology and implantable cardioverter defibrillator clinics attached to two tertiary hospitals in Melbourne, Australia, and two in Kentucky, the United States. Results: Participants with insufficient implantable cardioverter defibrillator knowledge (n = 77, 29%) were significantly older (mean age 66 vs 60 years, p = 0.001), less likely to be Caucasian (77% vs 87%, p = 0.047), less likely to have received implantable cardioverter defibrillator shocks (26% vs 40%, p = 0.031), and more likely to have indications of mild cognitive impairment (Montreal Cognitive Assessment score <24: 44% vs 16%, p < 0.001). Insufficient implantable cardioverter defibrillator knowledge was associated with attitudes suggesting unwillingness to discuss implantable cardioverter defibrillator deactivation, even during the last days towards end of life (p < 0.05). Conclusion: Implantable cardioverter defibrillator recipients, especially those who are older or have mild cognitive impairment, often have limited knowledge about implantable cardioverter defibrillator deactivation. This study identified several potential teachable moments throughout the patients’ treatment trajectory. An interdisciplinary approach is required to ensure that discussions about implantable cardioverter defibrillator deactivation issues are initiated at appropriate time points, with family members ideally also included.

Original languageEnglish
Pages (from-to)156-163
Number of pages8
JournalPalliative Medicine
Volume32
Issue number1
DOIs
Publication statusPublished - 1 Jan 2018

Keywords

  • attitudes
  • device deactivation
  • end-of-life discussions
  • Implantable cardioverter defibrillator
  • knowledge

Cite this

McEvedy, Samantha M. ; Cameron, Jan ; Lugg, Eugene ; Miller, Jennifer ; Haedtke, Chris ; Hammash, Muna ; Biddle, Martha J. ; Lee, Kyoung Suk ; Mariani, Justin A. ; Ski, Chantal F. ; Thompson, David R. ; Chung, Misook Lee ; Moser, Debra K. / Implantable cardioverter defibrillator knowledge and end-of-life device deactivation : A cross-sectional survey. In: Palliative Medicine. 2018 ; Vol. 32, No. 1. pp. 156-163.
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title = "Implantable cardioverter defibrillator knowledge and end-of-life device deactivation: A cross-sectional survey",
abstract = "Background: End-of-life implantable cardioverter defibrillator deactivation discussions should commence before device implantation and be ongoing, yet many implantable cardioverter defibrillators remain active in patients’ last days. Aim: To examine associations among implantable cardioverter defibrillator knowledge, patient characteristics and attitudes to implantable cardioverter defibrillator deactivation. Design: Cross-sectional survey using the Experiences, Attitudes and Knowledge of End-of-Life Issues in Implantable Cardioverter Defibrillator Patients Questionnaire. Participants were classified as insufficient or sufficient implantable cardioverter defibrillator knowledge and the two groups were compared. Setting/participants: Implantable cardioverter defibrillator recipients (n = 270, mean age 61 ± 14 years; 73{\%} male) were recruited from cardiology and implantable cardioverter defibrillator clinics attached to two tertiary hospitals in Melbourne, Australia, and two in Kentucky, the United States. Results: Participants with insufficient implantable cardioverter defibrillator knowledge (n = 77, 29{\%}) were significantly older (mean age 66 vs 60 years, p = 0.001), less likely to be Caucasian (77{\%} vs 87{\%}, p = 0.047), less likely to have received implantable cardioverter defibrillator shocks (26{\%} vs 40{\%}, p = 0.031), and more likely to have indications of mild cognitive impairment (Montreal Cognitive Assessment score <24: 44{\%} vs 16{\%}, p < 0.001). Insufficient implantable cardioverter defibrillator knowledge was associated with attitudes suggesting unwillingness to discuss implantable cardioverter defibrillator deactivation, even during the last days towards end of life (p < 0.05). Conclusion: Implantable cardioverter defibrillator recipients, especially those who are older or have mild cognitive impairment, often have limited knowledge about implantable cardioverter defibrillator deactivation. This study identified several potential teachable moments throughout the patients’ treatment trajectory. An interdisciplinary approach is required to ensure that discussions about implantable cardioverter defibrillator deactivation issues are initiated at appropriate time points, with family members ideally also included.",
keywords = "attitudes, device deactivation, end-of-life discussions, Implantable cardioverter defibrillator, knowledge",
author = "McEvedy, {Samantha M.} and Jan Cameron and Eugene Lugg and Jennifer Miller and Chris Haedtke and Muna Hammash and Biddle, {Martha J.} and Lee, {Kyoung Suk} and Mariani, {Justin A.} and Ski, {Chantal F.} and Thompson, {David R.} and Chung, {Misook Lee} and Moser, {Debra K.}",
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McEvedy, SM, Cameron, J, Lugg, E, Miller, J, Haedtke, C, Hammash, M, Biddle, MJ, Lee, KS, Mariani, JA, Ski, CF, Thompson, DR, Chung, ML & Moser, DK 2018, 'Implantable cardioverter defibrillator knowledge and end-of-life device deactivation: A cross-sectional survey', Palliative Medicine, vol. 32, no. 1, pp. 156-163. https://doi.org/10.1177/0269216317718438

Implantable cardioverter defibrillator knowledge and end-of-life device deactivation : A cross-sectional survey. / McEvedy, Samantha M.; Cameron, Jan; Lugg, Eugene; Miller, Jennifer; Haedtke, Chris; Hammash, Muna; Biddle, Martha J.; Lee, Kyoung Suk; Mariani, Justin A.; Ski, Chantal F.; Thompson, David R.; Chung, Misook Lee; Moser, Debra K.

In: Palliative Medicine, Vol. 32, No. 1, 01.01.2018, p. 156-163.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Implantable cardioverter defibrillator knowledge and end-of-life device deactivation

T2 - A cross-sectional survey

AU - McEvedy, Samantha M.

AU - Cameron, Jan

AU - Lugg, Eugene

AU - Miller, Jennifer

AU - Haedtke, Chris

AU - Hammash, Muna

AU - Biddle, Martha J.

AU - Lee, Kyoung Suk

AU - Mariani, Justin A.

AU - Ski, Chantal F.

AU - Thompson, David R.

AU - Chung, Misook Lee

AU - Moser, Debra K.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: End-of-life implantable cardioverter defibrillator deactivation discussions should commence before device implantation and be ongoing, yet many implantable cardioverter defibrillators remain active in patients’ last days. Aim: To examine associations among implantable cardioverter defibrillator knowledge, patient characteristics and attitudes to implantable cardioverter defibrillator deactivation. Design: Cross-sectional survey using the Experiences, Attitudes and Knowledge of End-of-Life Issues in Implantable Cardioverter Defibrillator Patients Questionnaire. Participants were classified as insufficient or sufficient implantable cardioverter defibrillator knowledge and the two groups were compared. Setting/participants: Implantable cardioverter defibrillator recipients (n = 270, mean age 61 ± 14 years; 73% male) were recruited from cardiology and implantable cardioverter defibrillator clinics attached to two tertiary hospitals in Melbourne, Australia, and two in Kentucky, the United States. Results: Participants with insufficient implantable cardioverter defibrillator knowledge (n = 77, 29%) were significantly older (mean age 66 vs 60 years, p = 0.001), less likely to be Caucasian (77% vs 87%, p = 0.047), less likely to have received implantable cardioverter defibrillator shocks (26% vs 40%, p = 0.031), and more likely to have indications of mild cognitive impairment (Montreal Cognitive Assessment score <24: 44% vs 16%, p < 0.001). Insufficient implantable cardioverter defibrillator knowledge was associated with attitudes suggesting unwillingness to discuss implantable cardioverter defibrillator deactivation, even during the last days towards end of life (p < 0.05). Conclusion: Implantable cardioverter defibrillator recipients, especially those who are older or have mild cognitive impairment, often have limited knowledge about implantable cardioverter defibrillator deactivation. This study identified several potential teachable moments throughout the patients’ treatment trajectory. An interdisciplinary approach is required to ensure that discussions about implantable cardioverter defibrillator deactivation issues are initiated at appropriate time points, with family members ideally also included.

AB - Background: End-of-life implantable cardioverter defibrillator deactivation discussions should commence before device implantation and be ongoing, yet many implantable cardioverter defibrillators remain active in patients’ last days. Aim: To examine associations among implantable cardioverter defibrillator knowledge, patient characteristics and attitudes to implantable cardioverter defibrillator deactivation. Design: Cross-sectional survey using the Experiences, Attitudes and Knowledge of End-of-Life Issues in Implantable Cardioverter Defibrillator Patients Questionnaire. Participants were classified as insufficient or sufficient implantable cardioverter defibrillator knowledge and the two groups were compared. Setting/participants: Implantable cardioverter defibrillator recipients (n = 270, mean age 61 ± 14 years; 73% male) were recruited from cardiology and implantable cardioverter defibrillator clinics attached to two tertiary hospitals in Melbourne, Australia, and two in Kentucky, the United States. Results: Participants with insufficient implantable cardioverter defibrillator knowledge (n = 77, 29%) were significantly older (mean age 66 vs 60 years, p = 0.001), less likely to be Caucasian (77% vs 87%, p = 0.047), less likely to have received implantable cardioverter defibrillator shocks (26% vs 40%, p = 0.031), and more likely to have indications of mild cognitive impairment (Montreal Cognitive Assessment score <24: 44% vs 16%, p < 0.001). Insufficient implantable cardioverter defibrillator knowledge was associated with attitudes suggesting unwillingness to discuss implantable cardioverter defibrillator deactivation, even during the last days towards end of life (p < 0.05). Conclusion: Implantable cardioverter defibrillator recipients, especially those who are older or have mild cognitive impairment, often have limited knowledge about implantable cardioverter defibrillator deactivation. This study identified several potential teachable moments throughout the patients’ treatment trajectory. An interdisciplinary approach is required to ensure that discussions about implantable cardioverter defibrillator deactivation issues are initiated at appropriate time points, with family members ideally also included.

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KW - device deactivation

KW - end-of-life discussions

KW - Implantable cardioverter defibrillator

KW - knowledge

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