Family involvement in decisions concerning implantable cardioverter defibrillators: results from an international survey.

Loreena Hill, Sonja McIlfatrick, Brian Taylor, Paul Slater, T. Jaarsma, A. Stromberg, Donna Fitzsimons

Research output: Contribution to conferenceAbstract

Abstract

Background: European and International expert guidelines recommend patients' with an Implantable Cardioverter Defibrillator (ICD) and their families are informed about deactivation. Recent empirical studies demonstrate diverse professional opinion regarding the involvement of family in the discussion about deactivation to dying patients.

Purpose: To determine the impact of family involvement on healthcare professionals' decision to discuss ICD deactivation.

Methods: Data from a systematic review, retrospective case note review and ten case studies identified social support as an important factor or Independent Variable (IV). The IV was classified into three levels, before being randomly assigned within vignettes of a factorial survey. The anonymised survey consisted of six vignettes, a demographic questionnaire and an opportunity for participants to record their most “recent case”. The survey was distributed electronically through a secure IT platform to healthcare professionals across Europe and America. Analysis included descriptive statistics, in addition to Multiple Regression and ANOVA to identify correlations between social support as an IV and two dependent variables. Thematic analysis was conducted on the qualitative data obtained from “recent cases”.

Results: A total of 1614 vignettes were completed by 269 professionals (168 nurses, 64 clinicians, 37 allied health professionals), mean age 46 years (range 26–65 years) with majority from Europe (n=217, 81%). Social support did not impact the likelihood of professionals' to discuss ICD deactivation (p=0.740). However, professionals who managed patients living with a family member who shared healthcare decisions with them, were significantly more confident (p=0.014) in discussing deactivation, compared to professionals caring for patients with no family support. Almost half of participants (N=35; 44%) who provided a recent case documented family involvement. This ranged from a supportive shared role “wife was terrified of seeing her husband shocked on his deathbed, contributing to a decision” (Healthcare Professional 1) to that of a surrogate decision-maker “family made the decision to deactivate the ICD as death was clos” (Healthcare Professional 2).

Conclusions: Family members can play an important role in the decision whether to deactivate an ICD, however this is contingent on their knowledge and previous involvement. Professionals should ensure families are involved in discussions and encourage shared decision-making. Further research is needed into the interventions required to support family members, ultimately improving end-of- life care for patients with an ICD.
Original languageEnglish
Publication statusPublished - Aug 2017
EventEuropean Society of Cardiology Congress 2017 - Barcelona , Spain
Duration: 26 Aug 201730 Aug 2017

Conference

ConferenceEuropean Society of Cardiology Congress 2017
CountrySpain
CityBarcelona
Period26/08/201730/08/2017

Fingerprint

Implantable Defibrillators
Delivery of Health Care
Social Support
Spouses
Surveys and Questionnaires
Nurse Clinicians
Allied Health Personnel
Terminal Care
Decision Making
Analysis of Variance
Demography
Guidelines

Cite this

Hill, L., McIlfatrick, S., Taylor, B., Slater, P., Jaarsma, T., Stromberg, A., & Fitzsimons, D. (2017). Family involvement in decisions concerning implantable cardioverter defibrillators: results from an international survey.. Abstract from European Society of Cardiology Congress 2017 , Barcelona , Spain.
Hill, Loreena ; McIlfatrick, Sonja ; Taylor, Brian ; Slater, Paul ; Jaarsma, T. ; Stromberg, A. ; Fitzsimons, Donna. / Family involvement in decisions concerning implantable cardioverter defibrillators: results from an international survey. Abstract from European Society of Cardiology Congress 2017 , Barcelona , Spain.
@conference{1518875e1d874cb1989bf89417f8ce66,
title = "Family involvement in decisions concerning implantable cardioverter defibrillators: results from an international survey.",
abstract = "Background: European and International expert guidelines recommend patients' with an Implantable Cardioverter Defibrillator (ICD) and their families are informed about deactivation. Recent empirical studies demonstrate diverse professional opinion regarding the involvement of family in the discussion about deactivation to dying patients.Purpose: To determine the impact of family involvement on healthcare professionals' decision to discuss ICD deactivation.Methods: Data from a systematic review, retrospective case note review and ten case studies identified social support as an important factor or Independent Variable (IV). The IV was classified into three levels, before being randomly assigned within vignettes of a factorial survey. The anonymised survey consisted of six vignettes, a demographic questionnaire and an opportunity for participants to record their most “recent case”. The survey was distributed electronically through a secure IT platform to healthcare professionals across Europe and America. Analysis included descriptive statistics, in addition to Multiple Regression and ANOVA to identify correlations between social support as an IV and two dependent variables. Thematic analysis was conducted on the qualitative data obtained from “recent cases”.Results: A total of 1614 vignettes were completed by 269 professionals (168 nurses, 64 clinicians, 37 allied health professionals), mean age 46 years (range 26–65 years) with majority from Europe (n=217, 81{\%}). Social support did not impact the likelihood of professionals' to discuss ICD deactivation (p=0.740). However, professionals who managed patients living with a family member who shared healthcare decisions with them, were significantly more confident (p=0.014) in discussing deactivation, compared to professionals caring for patients with no family support. Almost half of participants (N=35; 44{\%}) who provided a recent case documented family involvement. This ranged from a supportive shared role “wife was terrified of seeing her husband shocked on his deathbed, contributing to a decision” (Healthcare Professional 1) to that of a surrogate decision-maker “family made the decision to deactivate the ICD as death was clos” (Healthcare Professional 2).Conclusions: Family members can play an important role in the decision whether to deactivate an ICD, however this is contingent on their knowledge and previous involvement. Professionals should ensure families are involved in discussions and encourage shared decision-making. Further research is needed into the interventions required to support family members, ultimately improving end-of- life care for patients with an ICD.",
author = "Loreena Hill and Sonja McIlfatrick and Brian Taylor and Paul Slater and T. Jaarsma and A. Stromberg and Donna Fitzsimons",
year = "2017",
month = "8",
language = "English",
note = "European Society of Cardiology Congress 2017 ; Conference date: 26-08-2017 Through 30-08-2017",

}

Hill, L, McIlfatrick, S, Taylor, B, Slater, P, Jaarsma, T, Stromberg, A & Fitzsimons, D 2017, 'Family involvement in decisions concerning implantable cardioverter defibrillators: results from an international survey.', European Society of Cardiology Congress 2017 , Barcelona , Spain, 26/08/2017 - 30/08/2017.

Family involvement in decisions concerning implantable cardioverter defibrillators: results from an international survey. / Hill, Loreena; McIlfatrick, Sonja; Taylor, Brian; Slater, Paul; Jaarsma, T.; Stromberg, A.; Fitzsimons, Donna.

2017. Abstract from European Society of Cardiology Congress 2017 , Barcelona , Spain.

Research output: Contribution to conferenceAbstract

TY - CONF

T1 - Family involvement in decisions concerning implantable cardioverter defibrillators: results from an international survey.

AU - Hill, Loreena

AU - McIlfatrick, Sonja

AU - Taylor, Brian

AU - Slater, Paul

AU - Jaarsma, T.

AU - Stromberg, A.

AU - Fitzsimons, Donna

PY - 2017/8

Y1 - 2017/8

N2 - Background: European and International expert guidelines recommend patients' with an Implantable Cardioverter Defibrillator (ICD) and their families are informed about deactivation. Recent empirical studies demonstrate diverse professional opinion regarding the involvement of family in the discussion about deactivation to dying patients.Purpose: To determine the impact of family involvement on healthcare professionals' decision to discuss ICD deactivation.Methods: Data from a systematic review, retrospective case note review and ten case studies identified social support as an important factor or Independent Variable (IV). The IV was classified into three levels, before being randomly assigned within vignettes of a factorial survey. The anonymised survey consisted of six vignettes, a demographic questionnaire and an opportunity for participants to record their most “recent case”. The survey was distributed electronically through a secure IT platform to healthcare professionals across Europe and America. Analysis included descriptive statistics, in addition to Multiple Regression and ANOVA to identify correlations between social support as an IV and two dependent variables. Thematic analysis was conducted on the qualitative data obtained from “recent cases”.Results: A total of 1614 vignettes were completed by 269 professionals (168 nurses, 64 clinicians, 37 allied health professionals), mean age 46 years (range 26–65 years) with majority from Europe (n=217, 81%). Social support did not impact the likelihood of professionals' to discuss ICD deactivation (p=0.740). However, professionals who managed patients living with a family member who shared healthcare decisions with them, were significantly more confident (p=0.014) in discussing deactivation, compared to professionals caring for patients with no family support. Almost half of participants (N=35; 44%) who provided a recent case documented family involvement. This ranged from a supportive shared role “wife was terrified of seeing her husband shocked on his deathbed, contributing to a decision” (Healthcare Professional 1) to that of a surrogate decision-maker “family made the decision to deactivate the ICD as death was clos” (Healthcare Professional 2).Conclusions: Family members can play an important role in the decision whether to deactivate an ICD, however this is contingent on their knowledge and previous involvement. Professionals should ensure families are involved in discussions and encourage shared decision-making. Further research is needed into the interventions required to support family members, ultimately improving end-of- life care for patients with an ICD.

AB - Background: European and International expert guidelines recommend patients' with an Implantable Cardioverter Defibrillator (ICD) and their families are informed about deactivation. Recent empirical studies demonstrate diverse professional opinion regarding the involvement of family in the discussion about deactivation to dying patients.Purpose: To determine the impact of family involvement on healthcare professionals' decision to discuss ICD deactivation.Methods: Data from a systematic review, retrospective case note review and ten case studies identified social support as an important factor or Independent Variable (IV). The IV was classified into three levels, before being randomly assigned within vignettes of a factorial survey. The anonymised survey consisted of six vignettes, a demographic questionnaire and an opportunity for participants to record their most “recent case”. The survey was distributed electronically through a secure IT platform to healthcare professionals across Europe and America. Analysis included descriptive statistics, in addition to Multiple Regression and ANOVA to identify correlations between social support as an IV and two dependent variables. Thematic analysis was conducted on the qualitative data obtained from “recent cases”.Results: A total of 1614 vignettes were completed by 269 professionals (168 nurses, 64 clinicians, 37 allied health professionals), mean age 46 years (range 26–65 years) with majority from Europe (n=217, 81%). Social support did not impact the likelihood of professionals' to discuss ICD deactivation (p=0.740). However, professionals who managed patients living with a family member who shared healthcare decisions with them, were significantly more confident (p=0.014) in discussing deactivation, compared to professionals caring for patients with no family support. Almost half of participants (N=35; 44%) who provided a recent case documented family involvement. This ranged from a supportive shared role “wife was terrified of seeing her husband shocked on his deathbed, contributing to a decision” (Healthcare Professional 1) to that of a surrogate decision-maker “family made the decision to deactivate the ICD as death was clos” (Healthcare Professional 2).Conclusions: Family members can play an important role in the decision whether to deactivate an ICD, however this is contingent on their knowledge and previous involvement. Professionals should ensure families are involved in discussions and encourage shared decision-making. Further research is needed into the interventions required to support family members, ultimately improving end-of- life care for patients with an ICD.

M3 - Abstract

ER -

Hill L, McIlfatrick S, Taylor B, Slater P, Jaarsma T, Stromberg A et al. Family involvement in decisions concerning implantable cardioverter defibrillators: results from an international survey.. 2017. Abstract from European Society of Cardiology Congress 2017 , Barcelona , Spain.