Hill Loreena, McIlfatrick Sonja, Taylor Brian, Dixon Lana, Harbinson Mark, Fitzsimons Donna
Institute of Nursing Research, University of Ulster, Jordanstown Campus, Newtownabbey, UK Belfast Health and Social Care Trust, Belfast, UK
Institute of Nursing Research, University of Ulster, Jordanstown Campus, Newtownabbey, UK All Ireland Institute of Hospice & Palliative Care, Dublin, Ireland.
Palliat Med. 2015 Apr;29(4):310-23. doi: 10.1177/0269216314550374. Epub 2014 Sep 19.
Individualised care at the end of life requires professional understanding of the patient's perception of implantable cardioverter defibrillator deactivation.
The aim was to evaluate the evidence on patients' perception of implantable cardioverter defibrillator deactivation at end of life.
Systematic narrative review of empirical studies was published during 2008-2014.
Data were collected from six databases, citations from relevant articles and expert recommendations.
In all, 18 studies included with collective population of n = 5810. Concept mapping highlighted three themes: (1) Diverse preferences regarding discussion and deactivation. Deactivation was rarely discussed pre-implantation, with some studies demonstrating patients' reluctance to discuss implantable cardioverter defibrillator deactivation at any stage. Two studies found the majority of patients valued such discussions. Diversity was reflected in patients' willingness to deactivate, ranging from 12% (n = 9) in Irish cohort to 79% (n = 195) in Dutch study. (2) Ethical and legal considerations were predominant in Canadian and American literature as patients wanted to contribute but felt the decision should be a doctor's responsibility. Advance directives were uncommon in Europe, and where they existed the implantable cardioverter defibrillator was not mentioned. (3) 'Living in the now' was evident as despite deteriorating symptoms many patients maintained a positive outlook and anticipated surviving more than 10 years. Several studies asserted living longer was more important than quality of life.
Patients regard the implantable cardioverter defibrillator as a complex and solely beneficial device, with little insight regarding its potential impact on a peaceful death. This review confirms the need for professionals to discuss with patients and families implantable cardioverter defibrillator functionality and deactivation at appropriate opportunities.
临终个体化护理需要专业人员了解患者对植入式心脏复律除颤器停用的看法。
旨在评估有关患者对临终时植入式心脏复律除颤器停用看法的证据。
对2008年至2014年期间发表的实证研究进行系统的叙述性综述。
从六个数据库、相关文章的引用和专家建议中收集数据。
共纳入18项研究，总样本量为n = 5810。概念图突出了三个主题：（1）关于讨论和停用的不同偏好。植入前很少讨论停用问题，一些研究表明患者在任何阶段都不愿讨论植入式心脏复律除颤器的停用。两项研究发现大多数患者重视此类讨论。患者停用意愿的多样性有所体现，从爱尔兰队列中的12%（n = 9）到荷兰研究中的79%（n = 195）不等。（2）在加拿大和美国的文献中，伦理和法律考量占主导地位，因为患者希望参与决策，但认为决定权应由医生负责。生前预嘱在欧洲并不常见，即便存在，也未提及植入式心脏复律除颤器。（3）“活在当下”很明显，尽管症状不断恶化，许多患者仍保持积极的前景，并预期能存活超过10年。几项研究断言活得更长比生活质量更重要。
患者将植入式心脏复律除颤器视为一种复杂且完全有益的设备，对其对安详死亡的潜在影响了解甚少。本综述证实专业人员有必要在适当的时候与患者及其家属讨论植入式心脏复律除颤器的功能和停用问题。
