Krystina B. Lewis, MN, RN PhD candidate, School of Nursing, University of Ottawa, and Registered Nurse, University of Ottawa Health Institute, Ontario, Canada. David Birnie, MD Director of Arrhythmia Service, University of Ottawa Heart Institute, Ontario, Canada. Sandra L. Carroll, PhD, RN Associate Professor, School of Nursing, McMaster University, Hamilton, Ontario, Canada. Lorraine Clark, MHS, RN Clinical Manager, Clinical Services, University of Ottawa Heart Institute, Ontario, Canada. Freya Kelly, MN, RN Registered Nurse, University of Ottawa Heart Institute, Ontario, Canada. Paul Gibson Patient Partner, Health Consumer, Ottawa, Canada. Lloyd Rockburn Patient Partner, Health Consumer, Ottawa, Canada. Louise Rockburn Patient Partner, Health Consumer, Ottawa, Canada. Dawn Stacey, PhD, RN Professor, School of Nursing, University of Ottawa, and Senior Scientist, Ottawa Hospital Research Institute, Ontario, Canada.
J Cardiovasc Nurs. 2018 Sep/Oct;33(5):481-491. doi: 10.1097/JCN.0000000000000477.
Because of battery depletion, an implantable cardioverter-defibrillator (ICD) generator requires surgical replacement every 5 to 7 years. Routine replacement is the norm without discussion with patients about whether or not to proceed.
The aim of this study was to develop a patient decision aid (PDA) for patients facing ICD replacement and plan for its implementation.
An embedded mixed-methods study was conducted using questionnaires and semistructured interviews focused on current ICD replacement practices; PDA acceptability, usability, and content; and PDA implementation. Transcripts were analyzed using constant comparative analysis.
Eighteen PDA end users in 16 interviews characterized the current ICD replacement approach as automatic without consideration for patient preferences. The PDA was positively received, and the content was iteratively revised 4 times during the interviews. Changes were related to missing and excess information, language, and wording. The PDA was identified as a means to support a shared decision-making (SDM) process, not to be used as a standalone instrument. To shift current practices to an SDM process, participants identified that an invitation to discuss the option of ICD replacement is required-whether initiated by the patient or the clinician.
Currently, the option of ICD replacement is rarely offered, and patient preferences are seldom elicited. Participants believed the PDA to be a useful intervention that could help facilitate an SDM process for patients facing ICD replacement. Preparing for implementation during the development phase will allow us to strategize effectively to overcome perceived barriers and capitalize on perceived facilitators during actual implementation.
由于电池耗尽，植入式心脏复律除颤器 (ICD) 发生器每 5 到 7 年需要进行手术更换。在没有与患者讨论是否继续进行的情况下，常规更换是标准做法。
本研究旨在为面临 ICD 更换的患者开发一种患者决策辅助工具 (PDA)，并计划实施该工具。
采用问卷调查和半结构式访谈相结合的嵌入式混合方法研究，重点关注当前 ICD 更换实践；PDA 的可接受性、可用性和内容；以及 PDA 的实施。使用恒定比较分析对转录本进行分析。
16 次访谈中有 18 名 PDA 最终用户，他们将当前的 ICD 更换方法描述为自动进行，而没有考虑患者的偏好。PDA 受到了积极的评价，并且在访谈过程中对内容进行了 4 次迭代修改。变化与缺失和多余的信息、语言和措辞有关。PDA 被确定为支持共同决策 (SDM) 过程的一种手段，而不是作为独立的工具使用。为了将当前实践转变为 SDM 过程，参与者认为需要邀请患者或临床医生讨论 ICD 更换的选项。
目前，很少提供 ICD 更换的选项，也很少征求患者的偏好。参与者认为 PDA 是一种有用的干预措施，可以帮助面临 ICD 更换的患者促进 SDM 过程。在开发阶段为实施做准备将使我们能够有效地制定策略，以克服实施过程中感知到的障碍，并利用感知到的促进因素。
