Lambrakos Litsa K, Feigofsky Suzanne A, Wang Ying, Ahmed Fozia Z, Pachón Marta, Takata Theodore S, Frazier-Mills Camille G, Kotschet Emily, Gravelin Laura M, Hsu Jonathan C
Division of Cardiology, Department of Medicine, University of Miami Miller School of Medicine, 1321 NW 14th Street, Suite 510, Miami, FL, 33136, USA.
Iowa Heart Center, Carroll, IA, USA.
J Interv Card Electrophysiol. 2024 Dec;67(9):2077-2087. doi: 10.1007/s10840-024-01850-7. Epub 2024 Jul 13.
Implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy defibrillators (CRT-D) are lifesaving treatments for patients at risk for sudden cardiac death. Effective physician-patient communication during the shared decision-making process is essential. Electrophysiologist-patient conversations were targeted to obtain objective data on the interaction, understand the conversation framework, and uncover opportunities for improved communication.
Individuals previously identified as requiring an ICD/CRT-D but declined implantation were recruited for this four-stage interview and survey-based study. Quantitative analysis of surveys and AI analysis of conversation videos was conducted to evaluate patient participant expectations, analyze feedback about the conversations with study physicians, and gauge willingness for device implantation.
The study included 27 patients (mean age 51 years, 51.9% female) and 9 study physicians. Patients were significantly more willing to undergo ICD/CRT-D implantation after conversing with study physicians compared to their own physicians and pre-conversation surveys (mean scores: 5.0, 3.1, and 4.4 out of 7, respectively; p < 0.001). Patient participants had higher satisfaction with the study conversation, rating study physicians higher in effectiveness of explanations, responsiveness to questions, and overall quality of the conversation compared to their own physicians (all p < 0.001).
In a cohort of patients who previously declined ICD/CRT-D implantation, patient satisfaction and willingness to undergo implantation of a guideline-directed device therapy increased significantly following a structured conversation with study physicians. Identified key elements could be integrated into user-friendly tools and educational materials to facilitate these conversations, improving patient engagement with the decision-making process and enhancing informed acceptance of indicated device therapies.
植入式心脏复律除颤器（ICD）和心脏再同步治疗除颤器（CRT-D）是对有心脏性猝死风险患者的救命治疗方法。在共同决策过程中有效的医患沟通至关重要。对电生理学家与患者的对话进行针对性研究，以获取关于互动的客观数据，理解对话框架，并发现改善沟通的机会。
招募之前被确定需要植入ICD/CRT-D但拒绝植入的个体参与这项基于四阶段访谈和调查的研究。对调查进行定量分析，并对对话视频进行人工智能分析，以评估患者参与者的期望，分析他们对与研究医生对话的反馈，并衡量其植入设备的意愿。
该研究纳入了27名患者（平均年龄51岁，51.9%为女性）和9名研究医生。与他们自己的医生以及对话前的调查相比，患者在与研究医生交谈后更愿意接受ICD/CRT-D植入（平均得分分别为：7分制下的5.0分、3.1分和4.4分；p<0.001）。与他们自己的医生相比，患者参与者对研究对话的满意度更高，在解释的有效性、对问题的响应能力以及对话的整体质量方面对研究医生的评价更高（所有p<0.001）。
在一组之前拒绝植入ICD/CRT-D的患者中，与研究医生进行结构化对话后，患者的满意度和接受指南指导的设备治疗植入的意愿显著提高。确定的关键要素可整合到用户友好的工具和教育材料中，以促进这些对话，提高患者对决策过程的参与度，并增强对指定设备治疗的知情接受度。
