Journal article
"Why Would I Choose Death?" A Qualitative Study of Patient Understanding of the Role and Limitations of Cardiac Devices
The Journal of cardiovascular nursing, Vol.34(3), pp.275-282
05/01/2019
DOI: 10.1097/JCN.0000000000000565
PMCID: PMC6527421
PMID: 30789490
Abstract
Background: Although cardiology organizations recommend early introduction of palliative care for patients with heart failure (HF), integration has remained challenging, particularly in patients with cardiac devices such as cardiac implantable electronic devices and left ventricular assist devices. Study authors suggest that patients often have limited and erroneous understanding of these devices and their implications for future care. Objective: The aim of this study was to assess perceptions of cardiac devices in patients with HF and how these perceptions impacted advance care planning and future expectations. Methods: This study used qualitative semistructured interviews with 18 community-dwelling patients with New York Heart Association stage II to IV HF. Results: We interviewed 18 patients (mean ejection fraction, 38%; mean age, 64 years; 33% female; 83% white; 39% New York Heart Association class II, 39% class III, and 22% class IV). All had a cardiac implantable electronic device (6% permanent pacemaker, 56% implantable cardioverter-defibrillator, 28% biventricular implantable cardioverter-defibrillator); 11% had left ventricular assist devices. Patients with devices frequently misunderstood the impact of their device on cardiac function. A majority expressed the belief that the device would forestall further deterioration, regardless of whether this was the case. This anticipation of stability was often accompanied by the expectation that emerging technologies would continue to preempt decline. Citing this faith in technology, these patients frequently saw limited value in advance care planning. Conclusions: In our sample, patients with cardiac devices overestimated the impact of their devices on preventing disease progression and death and deprioritized advance care planning as a result.
Details
- Title: Subtitle
- "Why Would I Choose Death?" A Qualitative Study of Patient Understanding of the Role and Limitations of Cardiac Devices
- Creators
- Rachel A. Hadler - University of PennsylvaniaNathan E. Goldstein - Icahn School of Medicine at Mount SinaiDavid B. Bekelman - University of Colorado Anschutz Medical CampusBarbara Riegel - University of PennsylvaniaLarry A. Allen - University of Colorado HospitalRobert M. Arnold - University of PittsburghMatthew E. Harinstein - University of PittsburghDio Kavalieratos - University of Pittsburgh
- Resource Type
- Journal article
- Publication Details
- The Journal of cardiovascular nursing, Vol.34(3), pp.275-282
- DOI
- 10.1097/JCN.0000000000000565
- PMID
- 30789490
- PMCID
- PMC6527421
- NLM abbreviation
- J Cardiovasc Nurs
- ISSN
- 0889-4655
- eISSN
- 1550-5049
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 8
- Grant note
- National Palliative Care Research Center K12HS022989 / Agency for Healthcare Research and Quality; United States Department of Health & Human Services; Agency for Healthcare Research & Quality K01HL133466 / National Heart Lung and Blood Institute; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Heart Lung & Blood Institute (NHLBI) K01HL133466 / NATIONAL HEART, LUNG, AND BLOOD INSTITUTE; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Heart Lung & Blood Institute (NHLBI)
- Language
- English
- Date published
- 05/01/2019
- Academic Unit
- Anesthesia
- Record Identifier
- 9984296141402771
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