53 Please dont shock me: a qi project on implantable cardioverter defibrillators (icds) at the end of life care &amp; dnar

Javaid, Mahvesh Rana; Squirrell, Suzanne; Farooqi, Fahad

doi:10.1136/heartjnl-2017-311726.52

Cited by 1 publication

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“…To improve professional training a quality improvement project by Javid et al found targeted teaching, compared to posters or emails, had the biggest improvement in the occurrence of deactivation discussions. 39 Goldstein et al randomised control trial found the intervention group that received communication training were more likely to discuss goals of care than the control. 29 This suggests education and targeted workshops can help increase professional's awareness and confidence.…”

Section: Discussionmentioning

confidence: 99%

Implantable cardioverter defibrillator devices: when, how and who should discuss deactivation with patients: a systematic literature review

Freemantle

Murtagh

2021

BMJ Support Palliat Care

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BackgroundImplantable cardioverter defibrillators (ICDs) are used to treat life-threatening cardiac arrhythmias and prevent sudden cardiac arrest. As recipients age they may develop greater risk of dying as a result of progressive multimorbidity rather than sudden cardiac death. Defibrillation shocks may prolong an uncomfortable dying process. Deactivation of the defibrillator would prevent this, yet is not always discussed and planned.AimTo systematically review published evidence on ICD deactivation discussions and make recommendations on when, how and who should facilitate effective and patient-centred deactivation discussions.MethodsUsing standard systematic review methods, MEDLINE, EMBASE, CINAHL and PsycInfo were searched for studies published in the English language between 2010 and March 2021. Inclusion criteria were studies of adults (≥18 years) and including discussions on ICD deactivation and/or related communication. Included studies were independently reviewed, data extracted, quality assessed and data synthesised using a deductive approach.ResultsOf the 8893 articles identified, 22 papers met the inclusion criteria. Deductive approach led to identification of five main themes: (1) timing of ICD deactivation discussions, (2) initiation of deactivation discussions, (3) advance directives, (4) barriers to discussions and (5) facilitators of discussions.ConclusionsDespite available guidelines, conversations on device deactivation are not being undertaken consistently. Evidence suggests lack of professional awareness of guidelines and limited training in communication skills. To prevent distress and promote comfortable dying, there needs to be a proactive clinical and policy initiative in the education of both professionals and patients and their relatives about device deactivation.

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Section: Discussionmentioning

confidence: 99%