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Adult patient decision-making regarding implantation of complex cardiac devices: a scoping review
Alison Malecki-Ketchell1, Paul Marshall2, Joan Maclean3
11 School of Healthcare, University of Leeds, UK.
Insights
Patients deciding on cardiac rhythm management devices (CRMD) face challenges due to physical and psychosocial concerns. More research is needed to improve decision support for these complex choices.
Area of Science:
- Cardiology
- Medical Device Technology
- Patient Decision-Making
Background:
- Cardiac rhythm management devices (CRMD) offer survival benefits for sudden cardiac death risk.
- Implantation involves significant physical and psychosocial challenges for patients and physicians.
- Patient decision-making for CRMD therapy is complex and requires careful consideration.
Purpose of the Study:
- To conduct a scoping review exploring patient decision-making processes for CRMD implantation.
- To understand how adult patients (over 16 years) approach decisions regarding CRMD therapy.
Main Methods:
- Searched eight healthcare databases for English-language, peer-reviewed studies from 2000-2016.
- Included studies focused on patient decision-making for first-time CRMD implantation.
- Utilized the mixed methods appraisal tool for quality assessment of eligible studies.
Main Results:
- Synthesized findings from eight qualitative and seven quantitative studies.
- Identified two main themes: knowledge acquisition and the decision-making process.
- Highlighted similarities and differences with general treatment decision-making literature.
Conclusions:
- Gained insight into patient approaches to CRMD decision-making.
- Identified a lack of clarity and research specific to CRMD patients.
- Recommended further research to develop targeted decision support mechanisms.
Background:
Complex cardiac rhythm management device (CRMD) therapy provides an important treatment option for people at risk of sudden cardiac death. Despite the survival benefit, device implantation is associated with significant physical and psychosocial concerns presenting considerable challenges for the decision-making process surrounding CRMD implantation for patients and physicians.
Aims:
The purpose of this scoping review was to explore what is known about how adult (>16 years) patients make decisions regarding implantation of CRMD therapy.
Methods:
Published, peer reviewed, English language studies from 2000 to 2016 were identified in a search across eight healthcare databases. Eligible studies were concerned with patient decision-making for first time device implantation. Quality assessment was completed using the mixed methods appraisal tool for all studies meeting the inclusion criteria.
Results:
The findings of eight qualitative and seven quantitative studies, including patients who accepted or declined primary or secondary sudden cardiac death prevention devices, were clustered into two themes: knowledge acquisition and the process of decision-making, exposing similarities and distinctions with the treatment decision-making literature.
Conclusion:
The review revealed some insight in to the way patients approach decision-making but also exposed a lack of clarity and research activity specific to CRMD patients. Further research is recommended to support the development and application of targeted decision support mechanisms.
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