Quality of decision making is related to decision outcome for patients with cardiac arrhythmia

Langseth, Miriam Sjåstad; Shepherd, Ewen; Thomson, Richard; Lord, Sue

doi:10.1016/j.pec.2011.07.028

Cited by 15 publications

(21 citation statements)

References 11 publications

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“…Communication style strengths of geriatricians included informing the patient and caregivers about the current problem (Item 1), listing options available (Item 4) and indicating the consult had reached a decision‐making stage (Item 11). Lower scores were reported for eliciting the patient and caregiver's preferred approach to receiving information (Item 3) and exploring concerns and fears (Item 7) and have also been previously reported in psychiatry, cardiology and family medicine . As part of the intervention, patients and caregivers were provided with information face to face, via audio recordings and written summaries which included images, so it could be argued that Item 3 was less relevant in the context of this study.…”

Section: Discussionmentioning

confidence: 65%

“…The patients involved in this study are older than those in previous studies of SDM in psychiatry, oncology and cardiology but similar to previous studies in an intermediate care setting . The inclusion of participants with cognitive impairment is also unique in investigation into SDM competency to date.…”

Section: Discussionmentioning

confidence: 68%

“…We found that higher clinician SDM competency was displayed in meetings of longer duration. This appears to be a key finding across a range of settings, including depression care, general practice, oncology and family medicine but not in cardiology . Effective communication between clinicians, patients and caregivers on the complex and multiple problems that occur in older people following an acute hospital admission takes time.…”

Section: Discussionmentioning

confidence: 99%

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Family meetings for older adults in intermediate care settings: the impact of patient cognitive impairment and other characteristics on shared decision making

Milte

Ratcliffe

Davies

et al. 2013

Health Expectations

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Background Clinicians, older adults and caregivers frequently meet to make decisions around treatment and lifestyle during an acute hospital admission. Patient age, psychological status and health locus of control (HLC) influence patient preference for consultation involvement and information but overall, a shared-decisionmaking (SDM) approach is favoured. However, it is not known whether these characteristics and the presence of cognitive impairment influence SDM competency during family meetings.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

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Family meetings for older adults in intermediate care settings: the impact of patient cognitive impairment and other characteristics on shared decision making

Milte

Ratcliffe

Davies

et al. 2013

Health Expectations

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“…However, recent work locally suggests that patients who are more involved in decisions about ICD implantations may be less inclined to have a device fitted. 23 Near the end of life, shocks from ICDs may cause unnecessary pain and suffering for the patient and distress for carers and family members. 11,12 Currently, research suggests that one in four patients experiences shocks during the last month of life.…”

Section: Structure Of the Reportmentioning

confidence: 99%

“…Members of our research team have led and contributed to several studies on variation in the use of ICDs, 19 patient involvement in decision-making about cardiac devices, 23 patient and clinician perceptions of ICD decision-making, 40 and the development of decision support. 41,42 To date, much of the existing (mostly North American) evidence is concerned with what happens in specialist centres, with little consideration of earlier stages of decision-making, particularly in secondary care for initial referral decisions.…”

mentioning

confidence: 99%

A qualitative study of decision-making about the implantation of cardioverter defibrillators and deactivation during end-of-life care

Standing

Exley

Flynn

et al. 2016

Health Serv Deliv Res

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Background Implantable cardioverter defibrillators (ICDs) are recommended for patients at high risk of sudden cardiac death or for survivors of cardiac arrest. All ICDs combine a shock function with a pacing function to treat fast and slow heart rhythms, respectively. The pacing function may be very sophisticated and can provide so-called cardiac resynchronisation therapy for the treatment of heart failure using a pacemaker (cardiac resynchronisation therapy with pacemaker) or combined with an ICD [cardiac resynchronisation therapy with defibrillator (CRT-D)]. Decision-making about these devices involves considering the benefit (averting sudden cardiac death), possible risks (inappropriate shocks and psychological problems) and the potential need for deactivation towards the end of life. Objectives To explore patients’/relatives’ and clinicians’ views/experiences of decision-making about ICD and CRT-D implantation and deactivation, to establish how and when ICD risks, benefits and consequences are communicated to patients, to identify individual and organisational facilitators and barriers to discussions about implantation and deactivation and to determine information and decision-support needs for shared decision-making (SDM). Data sources Observations of clinical encounters, in-depth interviews and interactive group workshops with clinicians, patients and their relatives. Methods Observations of consultations with patients being considered for ICD or CRT-D implantation were undertaken to become familiar with the clinical environment and to optimise the sampling strategy. In-depth interviews were conducted with patients, relatives and clinicians to gain detailed insights into their views and experiences. Data collection and analysis occurred concurrently. Interactive workshops with clinicians and patients/relatives were used to validate our findings and to explore how these could be used to support better SDM. Results We conducted 38 observations of clinical encounters, 80 interviews (44 patients/relatives, seven bereaved relatives and 29 clinicians) and two workshops with 11 clinicians and 11 patients/relatives. Patients had variable knowledge about their conditions, the risk of sudden cardiac death and the clinical rationale for ICDs, which sometimes resulted in confusion about the potential benefits. Clinicians used various metaphors, verbal descriptors and numerical risk methods, including variable disclosure of the potential negative impact of ICDs on body image and the risk of psychological problems, to convey information to patients/relatives. Patients/relatives wanted more information about, and more involvement in, deactivation decisions, and expressed a preference that these decisions be addressed at the time of implantation. There was no consensus among clinicians about the initiation or timing of such discussions, or who should take responsibility for them. Introducing deactivation discussions prior to implantation was thus contentious; however, trigger points for deactivation discussions embedded within the pathway were suggested to ensure timely discussions. Limitations Only two patients who were prospectively considering deactivation and seven bereaved relatives were recruited. The study also lacks the perspectives of primary care clinicians. Conclusions There is discordance between patients and clinicians on information requirements, in particular the potential consequences of implantation on psychological well-being and quality of life in the short and long term (deactivation). There were no agreed points across the care pathway at which to discuss deactivation. Codesigned information tools that present balanced information on the benefits, risks and consequences, and SDM skills training for patients/relative and clinicians, would support better SDM about ICDs. Future work Multifaceted SDM interventions that focus on skills development for SDM combined with decision-support tools are warranted, and there is a potential central role for heart failure nurses and physiologists in supporting and preparing patients/relatives for such discussions. Funding The National Institute for Health Research Health Services and Delivery Research programme.

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Information Sharing and Shared Decision Making

Silverman

2015

Clinical Communication in Medicine

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Quality of decision making is related to decision outcome for patients with cardiac arrhythmia

Cited by 15 publications

References 11 publications

Family meetings for older adults in intermediate care settings: the impact of patient cognitive impairment and other characteristics on shared decision making

Family meetings for older adults in intermediate care settings: the impact of patient cognitive impairment and other characteristics on shared decision making

A qualitative study of decision-making about the implantation of cardioverter defibrillators and deactivation during end-of-life care

Information Sharing and Shared Decision Making

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