植入式心脏复律除颤器知识与生命终末期设备去激活：一项横断面调查。
Implantable cardioverter defibrillator knowledge and end-of-life device deactivation: A cross-sectional survey.
机构信息
1 School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.
2 Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia.
出版信息
Palliat Med. 2018 Jan;32(1):156-163. doi: 10.1177/0269216317718438. Epub 2017 Jul 5.
BACKGROUND
End-of-life implantable cardioverter defibrillator deactivation discussions should commence before device implantation and be ongoing, yet many implantable cardioverter defibrillators remain active in patients' last days.
AIM
To examine associations among implantable cardioverter defibrillator knowledge, patient characteristics and attitudes to implantable cardioverter defibrillator deactivation.
DESIGN
Cross-sectional survey using the Experiences, Attitudes and Knowledge of End-of-Life Issues in Implantable Cardioverter Defibrillator Patients Questionnaire. Participants were classified as insufficient or sufficient implantable cardioverter defibrillator knowledge and the two groups were compared.
SETTING/PARTICIPANTS: Implantable cardioverter defibrillator recipients ( n = 270, mean age 61 ± 14 years; 73% male) were recruited from cardiology and implantable cardioverter defibrillator clinics attached to two tertiary hospitals in Melbourne, Australia, and two in Kentucky, the United States.
RESULTS
Participants with insufficient implantable cardioverter defibrillator knowledge ( n = 77, 29%) were significantly older (mean age 66 vs 60 years, p = 0.001), less likely to be Caucasian (77% vs 87%, p = 0.047), less likely to have received implantable cardioverter defibrillator shocks (26% vs 40%, p = 0.031), and more likely to have indications of mild cognitive impairment (Montreal Cognitive Assessment score <24: 44% vs 16%, p < 0.001). Insufficient implantable cardioverter defibrillator knowledge was associated with attitudes suggesting unwillingness to discuss implantable cardioverter defibrillator deactivation, even during the last days towards end of life ( p < 0.05).
CONCLUSION
Implantable cardioverter defibrillator recipients, especially those who are older or have mild cognitive impairment, often have limited knowledge about implantable cardioverter defibrillator deactivation. This study identified several potential teachable moments throughout the patients' treatment trajectory. An interdisciplinary approach is required to ensure that discussions about implantable cardioverter defibrillator deactivation issues are initiated at appropriate time points, with family members ideally also included.
背景
心脏植入式除颤器（ICD）的末期去激活讨论应该在设备植入前开始，并持续进行，但许多 ICD 仍在患者生命的最后几天处于激活状态。
目的
探讨 ICD 知识、患者特征和对 ICD 去激活的态度之间的关联。
设计
使用“关于心脏植入式除颤器患者末期问题的经验、态度和知识问卷”进行横断面调查。参与者被分为 ICD 知识不足或充足的两组，并对两组进行比较。
地点/参与者：从澳大利亚墨尔本的两家三级医院和美国肯塔基州的两家医院的心脏病学和 ICD 诊所招募了 270 名 ICD 接受者（平均年龄 61 ± 14 岁；73%为男性）。
结果
ICD 知识不足的参与者（n=77，29%）年龄明显较大（平均年龄 66 岁 vs 60 岁，p=0.001），白种人比例较低（77% vs 87%，p=0.047），较少接受 ICD 电击（26% vs 40%，p=0.031），更有可能存在轻度认知障碍的迹象（蒙特利尔认知评估得分<24：44% vs 16%，p<0.001）。ICD 知识不足与不愿讨论 ICD 去激活的态度相关，即使在生命末期也如此（p<0.05）。
结论
ICD 接受者，尤其是年龄较大或有轻度认知障碍的患者，往往对 ICD 去激活知之甚少。本研究确定了患者治疗过程中的几个潜在的可教时刻。需要采取多学科方法，确保在适当的时间点开始讨论 ICD 去激活问题，最好让家属也参与进来。
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