Im Not Sure We Had A Choice?: Decision Quality and The Use of Cardiac Implantable Electronic Devices In Older Adults With Cognitive Impairment

Abstract

Background The decision to implant a cardiac device in a person with Alzheimer’s disease or related dementia requires considering the possible trade-offs of quality of life (QOL) and quantity of life. This study measured the decision-making experience of patients with and without cognitive impairment (CI) who received a cardiac device and their family members who were involved in the decision. Methods and Results Semi-structured interviews and questionnaires were administered with 15 patient-family member dyads. Interviews revealed few conversations between physicians, patients and family members about the patient’s cognitive status or about the benefits, risks, and long-term implications of the device for someone with CI. Participants largely stated that the decision to get the device was based on the patient’s functional status at the time of the implant, and not on expectations about future functioning. Patients with CI had more regret, measured with the Decision Regret Scale (DRS), (p=0.037) and family members of patients without CI reported more decisional conflict, measured with the Decisional Conflict Scale (p=0.057). Conclusions Although CI impacts life expectancy and QOL, cognitive status was largely not discussed prior to device implant. Few differences were found between the experiences of dyads that included patients with or without CI.

Dyadic Decision-Making in Advanced Parkinson’s Disease: A Mixed Methods Study

“…No significant differences were found on paired t -test between the PWP and of the family member on any of the three decisional scales or within participants between time 1 and time 2. Overall, participants had very low regret and conflict scores, and the scores were lower than reported in other samples (Fowler et al, 2018). These low scores were also occurring in cases even where six months later new decisions had to be made.…”

“…Higher scores indicate more conflict with a decision. The DCS has been widely used in more than 200 studies including recent research with dyads in cognitive impairment (Fowler et al, 2018). The stem of the introduction was individualized with the decision that the dyad had identified; thus, the responses were given in the context of the specific decision.…”

“…Lower conflict and lower regret scores suggest decisions are informed and consistent with personal values. Informed decisions and decisions consistent with one’s values are indicative of decisional quality in the ODSF (Fowler et al, 2018; Ottawa Hospital Research Institute, 2018).…”

“…No specific research studies have been identified that examine the types of decisions being made in advanced PD nor do any studies that examine satisfaction with decisions in PD dyads exist. Dyadic decision-making experiences research remains very limited, and the existing literature is a few studies involving lung cancer or cardiac implantable electronic device dyads (Fowler et al, 2018; Miller, Sullivan & Lyons, 2017)…”

Predictors of Regret among Older Men after Stress Urinary Incontinence Treatment Decisions

“…10e12 An established cut point >25 was selected a priori and used to indicate "moderate to severe regret," while a score 25 was used to indicate "no to minimal regret." 13,14 The DRS user manual provides details about the questions and scoring (https://decisionaid.ohri.ca/docs/ develop/User_Manuals/UM_Regret_Scale.pdf).…”