The Dutch Implantable Cardioverter-Defibrillator Decision Aid in Clinical Practice: A Stepped-Wedge Randomized...

Area of Science:

• Clinical Decision Making
• Medical Device Technology
• Patient Education

Background:

• Shared decision making (SDM) is crucial for complex medical choices like implantable cardioverter-defibrillator (ICD) therapy.
• Existing decision aids aim to support patients and providers in these nuanced discussions.
• The effectiveness of specific tools, like the Dutch ICD Decision Aid, requires rigorous evaluation.

Purpose of the Study:

• To evaluate the impact of the Dutch ICD Decision Aid on SDM in patients undergoing ICD implantation or replacement.
• To assess decisional conflict and patient knowledge levels in relation to the decision aid.
• To analyze factors influencing patient understanding and decision-making quality.

Main Methods:

• A stepped-wedge randomized controlled trial involving 150 patients and 233 healthcare providers across 6 Dutch hospitals.
• Assessment of SDM using SDM-Q-9 (patient) and SDM-Q-Doc (provider) questionnaires.
• Measurement of decisional conflict using the Decisional Conflict Scale (DCS); analysis of knowledge retention based on education and prior ICD experience.

Main Results:

• No significant differences in SDM scores were observed for either patients or healthcare providers between the intervention and control groups.
• Decisional conflict scores were consistently low across both groups, indicating effective decision-making processes.
• Patients with higher education and those undergoing pulse-generator exchange demonstrated better knowledge retention.

Conclusions:

• The Dutch ICD Decision Aid did not significantly alter SDM or decisional conflict, as baseline levels were already favorable.
• A notable gap in patient knowledge regarding ICD therapy persists, despite high SDM.
• Future efforts should focus on refining decision-making tools and enhancing patient-centered education to improve understanding and knowledge retention.