1
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McConnell T, Blair C, Burden J, Duddy C, Hill L, Howie C, Jones B, Ruane B, Wong G, Reid J. Integrating palliative care and heart failure: a systematic realist synthesis (PalliatHeartSynthesis). Open Heart 2023; 10:e002438. [PMID: 38097362 PMCID: PMC10729146 DOI: 10.1136/openhrt-2023-002438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 11/10/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES (1) Develop a programme theory of why, for whom and in what contexts integrated palliative care (PC) and heart failure (HF) services work/do not work; (2) use the programme theory to co-produce with stakeholders, intervention strategies to inform best practice and future research. METHODS A systematic review of all published articles and grey literature using a realist logic of analysis. The search strategy combined terms significant to the review questions: HF, PC and end of life. Documents were included if they were in English and provided data relevant to integration of PC and HF services. Searches were conducted in November 2021 in EMBASE, MEDLINE, PsycINFO, AMED, HMIC and CINAHL. Further relevant documents were identified via monthly alerts (up until April 2023) and the project stakeholder group (patient/carers, content experts and multidisciplinary practitioners). RESULTS 130 documents were included (86 research, 22 literature reviews, 22 grey literature). The programme theory identified intervention strategies most likely to support integration of PC and HF services. These included protected time for evidence-based PC and HF education from undergraduate/postgraduate level and continuing professional practice; choice of educational setting (eg, online, face-to-face or hybrid); increased awareness and seeing benefits of PC for HF management; conveying the emotive and intellectual need for integrating PC and HF via credible champions; and prioritising PC and HF guidelines in practice. CONCLUSIONS The review findings outline the required steps to take to increase the likelihood that all key players have the capacity, opportunity and motivation to integrate PC into HF management. PROSPERO REGISTRATION NUMBER CRD42021240185.
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Affiliation(s)
- Tracey McConnell
- School of Nursing and Midwifery, Queen's University Belfast Faculty of Medicine, Health and Life Sciences, Belfast, UK
| | - Carolyn Blair
- School of Nursing and Midwifery, Queen's University Belfast Faculty of Medicine, Health and Life Sciences, Belfast, UK
| | - John Burden
- Patient and Public Involvement Network members, British Heart Foundation, London, UK
| | - Claire Duddy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Loreena Hill
- School of Nursing and Midwifery, Queen's University Belfast Faculty of Medicine, Health and Life Sciences, Belfast, UK
| | - Clare Howie
- School of Nursing and Midwifery, Queen's University Belfast Faculty of Medicine, Health and Life Sciences, Belfast, UK
| | - Bob Jones
- Patient and Public Involvement Network members, British Heart Foundation, London, UK
| | - Bob Ruane
- Patient and Public Involvement Network members, British Heart Foundation, London, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Joanne Reid
- School of Nursing and Midwifery, Queen's University Belfast Faculty of Medicine, Health and Life Sciences, Belfast, UK
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2
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Callaghan EM, Diamandis-Nikoletatos E, van Leeuwen PP, Higgins JB, Somerville CE, Brown LJ, Schumacher TL. Communication regarding the deactivation of implantable cardioverter-defibrillators: A scoping review and narrative summary of current interventions. PATIENT EDUCATION AND COUNSELING 2022; 105:3431-3445. [PMID: 36055906 DOI: 10.1016/j.pec.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Communication about deactivation of implantable cardioverter-defibrillator (ICD) therapy at end-of-life (EoL) is a recognised issue within clinical practice. The aim of this scoping review was to explore and map the current literature in this field, with a focus on papers which implemented interventional studies. METHODS Systematic searches of six major databases were conducted. Citations were included by four researchers according to selection criteria. Key demographic data and prespecified themes in relation to communication of ICD deactivation at EoL were extracted. RESULTS The search found 6197 texts of which 63 were included: 39 quantitative, 14 qualitative and 10 mixed-methods. Surveys were predominantly used to gather data (n = 34), followed by interviews (n = 18) and retrospective reviews of patient records (n = 18). CONCLUSIONS Several key gaps in the literature warrant further research. These include who is responsible for initiating ICD deactivation discussions, how clinicians should initiate and conduct these discussions, when ICD deactivations should be occurring, and family perspectives. Adequately explored themes include patient and clinician knowledge and attitudes regarding ICD deactivation at EoL. PRACTICAL IMPLICATIONS Facilities treating patients with ICDs at EoL should consider ongoing quality improvement projects aimed at clinician education and protocol changes to improve communication surrounding EoL ICD deactivation.
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Affiliation(s)
- Ellen M Callaghan
- School of Medicine and Public Health (Joint Medical Program), University of Newcastle, Callaghan, NSW 2305, Australia; School of Rural Medicine (Joint Medical Program), University of New England, Armidale, NSW 2350, Australia
| | - Elly Diamandis-Nikoletatos
- School of Medicine and Public Health (Joint Medical Program), University of Newcastle, Callaghan, NSW 2305, Australia; School of Rural Medicine (Joint Medical Program), University of New England, Armidale, NSW 2350, Australia
| | - Paul P van Leeuwen
- School of Medicine and Public Health (Joint Medical Program), University of Newcastle, Callaghan, NSW 2305, Australia; School of Rural Medicine (Joint Medical Program), University of New England, Armidale, NSW 2350, Australia
| | - Jack B Higgins
- School of Medicine and Public Health (Joint Medical Program), University of Newcastle, Callaghan, NSW 2305, Australia; School of Rural Medicine (Joint Medical Program), University of New England, Armidale, NSW 2350, Australia
| | | | - Leanne J Brown
- Department of Rural Health, College of Health, Medicine and Wellbeing, University of Newcastle, Tamworth, NSW 2340, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Tracy L Schumacher
- Department of Rural Health, College of Health, Medicine and Wellbeing, University of Newcastle, Tamworth, NSW 2340, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia.
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3
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Lambrinou E, Decourcey J, Hill L. Personalizing Heart Failure Care to the Patient With Cancer. Curr Heart Fail Rep 2022; 19:1-6. [PMID: 35000125 DOI: 10.1007/s11897-021-00536-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The current review describes the role of the cardio-oncology nurse and the need for personalized heart failure care for the patient with cancer. RECENT FINDINGS It is a new role whereby cardiology or heart failure nurses care for patients with cancer who develop cardiotoxicity or cardiovascular diseases, either during the cancer therapy or in a later stage. Inter-disciplinary approach is important for individualized early treatment, shortened interruptions to cancer therapy, and irreversible cardiovascular injury prevention. Nurses have a key role in early evaluation and quality control of the care provided. This is a quite new clinical area and not much evidence exists for the development of clinical guidelines and pathways to support clinicians. More trials are needed for the development of clinical recommendations.
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Affiliation(s)
- Ekaterini Lambrinou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus.
| | | | - Loreena Hill
- School of Nursing and Midwifery, Queen's University, Belfast, Northern Ireland
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4
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Landry-Hould F, Mondésert B, Day AG, Ross HJ, Brouillette J, Clarke B, Zieroth S, Toma M, Parent MC, Fowler RA, You JJ, Ducharme A. Characteristics of Clinicians Are Associated With Their Beliefs About ICD Deactivation: Insight From the DECIDE-HF Study. CJC Open 2021; 3:994-1001. [PMID: 34505038 PMCID: PMC8413241 DOI: 10.1016/j.cjco.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/09/2021] [Indexed: 11/28/2022] Open
Abstract
Background Discussing goals of care with heart failure patients is recommended but is not done systematically, due to factors such as time and personal beliefs. A recent survey showed that one-fifth of clinicians believe that implantable cardioverter defibrillator deactivation (ICDD) is unethical or constitutes physician-assisted suicide. We investigated whether individuals’ characteristics are associated with these beliefs. Methods The Decision-Making About Goals of Care for Hospitalized Patients With Heart Failure (DECIDE-HF) survey was given to healthcare providers at 9 hospitals to assess their perceived barriers to goals-of-care discussions. The association between respondent characteristics and their beliefs was examined using 2 adjusted logistic regression models. Results We included 760 clinicians (459 nurses, 94 fellows, and 207 cardiologists). The responses varied among professions, with the belief that ICDD is unethical considered to be important barrier by nurses (24%), fellows (10%), and staff (7%); P < 0.001). After adjusting for site, spirituality being more important in life (odds ratio [OR]: 2.21; 95% confidence interval [CI]:1.37-3.56; P = 0.001, compared to less important), region of training (Asia [OR: 5.88; 95% CI: 2.12-16.31; P = 0.001] and Middle East [OR: 5.55; 95% CI:1.57-19.63; P = 0.008] compared to Canada), and years in practice (OR: 1.32; 95% CI: 1.07-1.63; P = 0.01 per decade) influenced beliefs about ICDD being unethical, with similar results for the belief that ICDD represents physician-assisted suicide. Conclusions Sociocultural factors, region of training, and profession influence clinicians’ beliefs about ICDD being unethical and representing physician-assisted suicide. These factors and beliefs must be acknowledged when facing the delicate issue of end-of-life discussion.
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Affiliation(s)
- Florence Landry-Hould
- Department of Medicine, Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - Blandine Mondésert
- Department of Medicine, Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - Andrew G Day
- Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada
| | - Heather J Ross
- Peter Munk Cardiac Center, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Judith Brouillette
- Departments of Psychiatry and Addictology, Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - Brian Clarke
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shelley Zieroth
- St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mustafa Toma
- Division of Cardiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marie-Claude Parent
- Department of Medicine, Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - Robert A Fowler
- Department of Medicine and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - John J You
- Department of Medicine, Division of General Internal and Hospitalist Medicine, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Anique Ducharme
- Department of Medicine, Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
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5
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Coats AJS. Figures of the Heart Failure Association: Loreena Hill (HFA Board Member and Nurse Representative 2016-2020, and HFA Secretary 2020-2022). Eur J Heart Fail 2021; 23:1572-1573. [PMID: 34357665 DOI: 10.1002/ejhf.2323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/02/2021] [Indexed: 11/07/2022] Open
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6
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Freemantle M, Murtagh F. Implantable cardioverter defibrillator devices: when, how and who should discuss deactivation with patients: a systematic literature review. BMJ Support Palliat Care 2021; 12:359-367. [PMID: 33963003 DOI: 10.1136/bmjspcare-2021-002894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Implantable cardioverter defibrillators (ICDs) are used to treat life-threatening cardiac arrhythmias and prevent sudden cardiac arrest. As recipients age they may develop greater risk of dying as a result of progressive multimorbidity rather than sudden cardiac death. Defibrillation shocks may prolong an uncomfortable dying process. Deactivation of the defibrillator would prevent this, yet is not always discussed and planned. AIM To systematically review published evidence on ICD deactivation discussions and make recommendations on when, how and who should facilitate effective and patient-centred deactivation discussions. METHODS Using standard systematic review methods, MEDLINE, EMBASE, CINAHL and PsycInfo were searched for studies published in the English language between 2010 and March 2021. Inclusion criteria were studies of adults (≥18 years) and including discussions on ICD deactivation and/or related communication. Included studies were independently reviewed, data extracted, quality assessed and data synthesised using a deductive approach. RESULTS Of the 8893 articles identified, 22 papers met the inclusion criteria. Deductive approach led to identification of five main themes: (1) timing of ICD deactivation discussions, (2) initiation of deactivation discussions, (3) advance directives, (4) barriers to discussions and (5) facilitators of discussions. CONCLUSIONS Despite available guidelines, conversations on device deactivation are not being undertaken consistently. Evidence suggests lack of professional awareness of guidelines and limited training in communication skills. To prevent distress and promote comfortable dying, there needs to be a proactive clinical and policy initiative in the education of both professionals and patients and their relatives about device deactivation.
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Affiliation(s)
- Megan Freemantle
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Fliss Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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7
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Stoevelaar R, Stoppelenburg A, van Bruchem-Visser RL, van Driel AG, Theuns DA, Lokker ME, Bhagwandien RE, Heide AVD, Rietjens JA. Advance care planning and end-of-life care in patients with an implantable cardioverter defibrillator: The perspective of relatives. Palliat Med 2021; 35:904-915. [PMID: 33845683 PMCID: PMC8114448 DOI: 10.1177/02692163211001288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Little is known about the last phase of life of patients with implantable cardioverter defibrillators and the practice of advance care planning in this population. AIM To describe the last phase of life and advance care planning process of patients with an implantable cardioverter defibrillator, and to assess relatives' satisfaction with treatment and care. DESIGN Mixed-methods study, including a survey and focus group study. SETTING/PARTICIPANTS A survey among 170 relatives (response rate 59%) reporting about 154 deceased patients, and 5 subsequent focus groups with 23 relatives. RESULTS Relatives reported that 38% of patients had a conversation with a healthcare professional about implantable cardioverter defibrillator deactivation. Patients' and relatives' lack of knowledge about device functioning and the perceived lack of time of healthcare professionals were frequently mentioned barriers to advance care planning. Twenty-four percent of patients experienced a shock in the last month of life, which were, according to relatives, distressing for 74% of patients and 73% of relatives. Forty-two to sixty-one percent of relatives reported to be satisfied with different aspects of end-of-life care, such as the way in which wishes of the patient were respected. Quality of death was scored higher for patients with a deactivated device than those with an active device (6.74 vs 5.67 on a 10-point scale, p = 0.012). CONCLUSIONS Implantable cardioverter defibrillator deactivation was discussed with a minority of patients. Device shocks were reported to be distressing to patients and relatives. Relatives of patients with a deactivated device reported a higher quality of death compared to relatives of patients with an active device.
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Affiliation(s)
- Rik Stoevelaar
- Department of Public Health, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Arianne Stoppelenburg
- Department of Public Health, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Anne Geert van Driel
- Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Dominic Amj Theuns
- Department of Cardiology, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Martine E Lokker
- Department of Public Health, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rohit E Bhagwandien
- Department of Cardiology, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Judith Ac Rietjens
- Department of Public Health, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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8
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Mc Elhinney H, Taylor BJ, Sinclair M. Judgements of health and social care professionals on a child protection referral of an unborn baby: Factorial survey. CHILD ABUSE & NEGLECT 2021; 114:104978. [PMID: 33582402 DOI: 10.1016/j.chiabu.2021.104978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 10/28/2020] [Accepted: 01/25/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Midwives and children's services social workers have responsibilities to identify and support pregnant women where there are child protection concerns. Professionals seek to anticipate the risk of harm and initiate interventions to provide support to families. There is little research on how professionals prioritise risk factors and the challenges they face in protecting unborn babies. OBJECTIVE To measure the impact of identified risk factors regarding child protection referrals of unborn babies on the professional judgements of midwives and children's services social workers. METHODS A factorial survey design using vignettes with randomised factors within a standardised structure, administered digitally using Qualtrics software. PARTICIPANTS & SETTING Midwives (n = 250) and children's services social workers (n = 88) from one Health and Social Care Trust in Northern Ireland. RESULTS One thousand and ninety-six vignettes were completed by 118 participants. Analysis using multiple regression showed that the risk factors together accounted for 44% of the variance in perceived risk of harm and of the variance on perceived need for a referral. The significant Independent Variables (IVs) in order included: drug use, alcohol use, age, antenatal care attendance, mental wellbeing, domestic violence and the pregnant woman's I the childhood experiences. There were no significant differences between midwives and social workers regarding judgements about important risk factors. CONCLUSIONS This survey provided an ordering of major risk factors influencing decision making to protect an unborn baby from the perspective of experienced social workers and midwives. The study helps professionals in judging the seriousness of risk factors. The interaction effects between risks requires further research.
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Affiliation(s)
- Helena Mc Elhinney
- Maternal Fetal and Infant Research Centre, Institute of Nursing and Health Research, Ulster University, Coleraine, UK.
| | - Brian J Taylor
- School of Applied Social & Policy Sciences, Ulster University, Coleraine, UK.
| | - Marlene Sinclair
- Maternal Fetal and Infant Research Centre, Institute of Nursing and Health Research, Ulster University, Coleraine, UK.
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9
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Hill L, Prager Geller T, Baruah R, Beattie JM, Boyne J, de Stoutz N, Di Stolfo G, Lambrinou E, Skibelund AK, Uchmanowicz I, Rutten FH, Čelutkienė J, Piepoli MF, Jankowska EA, Chioncel O, Ben Gal T, Seferovic PM, Ruschitzka F, Coats AJS, Strömberg A, Jaarsma T. Integration of a palliative approach into heart failure care: a European Society of Cardiology Heart Failure Association position paper. Eur J Heart Fail 2020; 22:2327-2339. [PMID: 32892431 DOI: 10.1002/ejhf.1994] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 12/18/2022] Open
Abstract
The Heart Failure Association of the European Society of Cardiology has published a previous position paper and various guidelines over the past decade recognizing the value of palliative care for those affected by this burdensome condition. Integrating palliative care into evidence-based heart failure management remains challenging for many professionals, as it includes the identification of palliative care needs, symptom control, adjustment of drug and device therapy, advance care planning, family and informal caregiver support, and trying to ensure a 'good death'. This new position paper aims to provide day-to-day practical clinical guidance on these topics, supporting the coordinated provision of palliation strategies as goals of care fluctuate along the heart failure disease trajectory. The specific components of palliative care for symptom alleviation, spiritual and psychosocial support, and the appropriate modification of guideline-directed treatment protocols, including drug deprescription and device deactivation, are described for the chronic, crisis and terminal phases of heart failure.
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Affiliation(s)
- Loreena Hill
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Tal Prager Geller
- Palliative Care Ward at Dorot Health Centre, Heart Failure Unit at Rabin Medical Center, Netanya, Israel
| | - Resham Baruah
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - James M Beattie
- Cicely Saunders Institute, King's College London, London, UK
| | - Josiane Boyne
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Giuseppe Di Stolfo
- Cardiovascular Department, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | | | - Izabella Uchmanowicz
- Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland.,Centre for Heart Diseases, University Hospital, Wroclaw, Poland
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Massimo Francesco Piepoli
- Heart Failure Unit, Cardiology, Guglielmo da Saliceto Hospital, Piacenza, Italy.,University of Parma, Parma, Italy
| | - Ewa A Jankowska
- Centre for Heart Diseases, University Hospital, Wroclaw, Poland.,Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania.,University of Medicine Carol Davila, Bucharest, Romania
| | - Tuvia Ben Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Petar M Seferovic
- Cardiology Department, Clinical Centre Serbia, Medical School Belgrade, Belgrade, Serbia
| | - Frank Ruschitzka
- Clinic for Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
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10
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Stoevelaar R, Brinkman-Stoppelenburg A, van Bruchem-Visser RL, van Driel AG, Bhagwandien RE, Theuns DAMJ, Rietjens JAC, van der Heide A. Implantable cardioverter defibrillators at the end of life: future perspectives on clinical practice. Neth Heart J 2020; 28:565-570. [PMID: 32548800 PMCID: PMC7596123 DOI: 10.1007/s12471-020-01438-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The implantable cardioverter defibrillator (ICD) is effective in terminating life-threatening arrhythmias. However, in the last phase of life, ICD shocks may no longer be appropriate. Guidelines recommend timely discussion with the patient regarding deactivation of the shock function of the ICD. However, research shows that such conversations are scarce, and some patients experience avoidable and distressful shocks in the final days of life. Barriers such as physicians’ lack of time, difficulties in finding the right time to discuss ICD deactivation, patients’ reluctance to discuss the topic, and the fragmentation of care, which obscures responsibilities, prevent healthcare professionals from discussing this topic with the patient. In this point-of-view article, we argue that healthcare professionals who are involved in the care for ICD patients should be better educated on how to communicate with patients about ICD deactivation and the end of life. Optimal communication is needed to reduce the number of patients experiencing inappropriate and painful shocks in the terminal stage of their lives.
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Affiliation(s)
- R Stoevelaar
- Department of Public Health, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands.
| | - A Brinkman-Stoppelenburg
- Department of Public Health, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - R L van Bruchem-Visser
- Department of Internal Medicine, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - A G van Driel
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
- Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - R E Bhagwandien
- Department of Cardiology, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - D A M J Theuns
- Department of Cardiology, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - J A C Rietjens
- Department of Public Health, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - A van der Heide
- Department of Public Health, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands
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11
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Hill L, Beattie JM, Geller TP, Baruah R, Boyne J, Stolfo GD, Jaarsma T. Palliative care: Essential support for patients with heart failure in the COVID-19 pandemic. Eur J Cardiovasc Nurs 2020; 19:469-472. [PMID: 32515212 PMCID: PMC7953953 DOI: 10.1177/1474515120932814] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Loreena Hill
- School of Nursing and Midwifery, Queen's University, Northern Ireland
| | | | | | | | - Josiane Boyne
- Department of Cardiology, Maastricht University Medical Centre, The Netherlands
| | - Giuseppe Di Stolfo
- Cardiovascular Department, Fondazione IRCCS Casa Sollievo della Sofferenza, Italy
| | - Tiny Jaarsma
- Department of Health, Medicine and Health Sciences, Linköping University, Sweden.,Julius Center, University Medical Center, The Netherlands
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12
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Dillon P, McDowell R, Smith SM, Gallagher P, Cousins G. Determinants of intentions to monitor antihypertensive medication adherence in Irish community pharmacy: a factorial survey. BMC FAMILY PRACTICE 2019; 20:131. [PMID: 31519171 PMCID: PMC6744667 DOI: 10.1186/s12875-019-1016-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 08/27/2019] [Indexed: 11/10/2022]
Abstract
Background Community pharmacy represents an important setting to identify patients who may benefit from an adherence intervention, however it remains unclear whether it would be feasible to monitor antihypertensive adherence within the workflow of community pharmacy. The aim of this study was to identify facilitators and barriers to monitoring antihypertensive medication adherence of older adults at the point of repeat dispensing. Methods We undertook a factorial survey of Irish community pharmacists, guided by a conceptual model adapted from the Theory of Planned Behaviour (TPB). Respondents completed four sections, 1) five factorial vignettes (clinical scenario of repeat dispensing), 2) a medication monitoring attitude measure, 3) subjective norms and self-efficacy questions, and 4) demographic and workplace questions. Barriers and facilitators to adherence monitoring behaviour were identified in factorial vignette analysis using multivariate multilevel linear modelling, testing the effect of both contextual factors embedded within the vignettes (section 1), and respondent-level factors (sections 2–4) on likelihood to perform three adherence monitoring behaviours in response to the vignettes. Results Survey invites (n = 1543) were sent via email and 258 completed online survey responses were received; two-thirds of respondents were women, and one-third were qualified pharmacists for at least 15 years. In factorial vignette analysis, pharmacists were more inclined to monitor antihypertensive medication adherence by examining refill-patterns from pharmacy records than asking patients questions about their adherence or medication beliefs. Pharmacists with more positive attitudes towards medication monitoring and normative beliefs that other pharmacists monitored adherence, were more likely to monitor adherence. Contextual factors also influenced pharmacists’ likelihood to perform the three adherence monitoring behaviours, including time-pressures and the number of days late the patient collected their repeat prescription. Pharmacists’ normative beliefs and the number of days late the patient collected their repeat prescription had the largest quantitative influence on responses. Conclusions This survey identified that positive pharmacist attitudes and normative beliefs can facilitate adherence monitoring within the current workflow; however contextual time-barriers may prevent adherence monitoring. Future research should consider these findings when designing a pharmacist-led adherence intervention to be integrated within current pharmacy workflow. Electronic supplementary material The online version of this article (10.1186/s12875-019-1016-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Paul Dillon
- School of Pharmacy, RCSI, St. Stephen's Green, Dublin 2, Ireland.
| | - Ronald McDowell
- HRB Centre for Primary Care Research, RCSI, St. Stephen's Green, Dublin 2, Ireland.,School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, Ireland
| | - Susan M Smith
- Department of General Practice and HRB Centre for Primary Care Research, RCSI, St. Stephen's Green, Dublin 2, Ireland
| | - Paul Gallagher
- School of Pharmacy, RCSI, St. Stephen's Green, Dublin 2, Ireland.,Department of Pharmacy, National University of Singapore, 18 Science Drive 4, Singapore, Singapore
| | - Gráinne Cousins
- School of Pharmacy, RCSI, St. Stephen's Green, Dublin 2, Ireland
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Stoevelaar R, Brinkman-Stoppelenburg A, van Driel AG, Theuns DA, Bhagwandien RE, van Bruchem-Visser RL, Lokker IE, van der Heide A, Rietjens JA. Trends in time in the management of the implantable cardioverter defibrillator in the last phase of life: a retrospective study of medical records. Eur J Cardiovasc Nurs 2019; 18:449-457. [PMID: 30995145 PMCID: PMC6661715 DOI: 10.1177/1474515119844660] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The implantable cardioverter defibrillator (ICD) might give unwanted shocks in the last month of life. Guidelines recommend deactivation of the ICD prior to death. AIMS The aims of this study were to examine trends in time (2007-2016) in how and when decisions are made about ICD deactivation, and to examine patient- and disease-related factors which may have influenced these decisions. In addition, care and ICD shock frequency in the last month of life of ICD patients are described. METHODS Medical records of a sample of deceased patients who had their ICD implanted in 1999-2015 in a Dutch university (n = 308) or general (n = 72) hospital were examined. RESULTS Median age at death was 71 years, and 88% were male. ICD deactivation discussions increased from 6% for patients who had died between 2007 and 2009 to 35% for patients who had died between 2013 and 2016. ICD deactivation rates increased in these periods from 16% to 42%. Presence of do-not-resuscitate (DNR) orders increased from 9% to 46%. Palliative care consultations increased from 0% to 9%. When the ICD remained active, shocks were reported for 7% of patients in the last month of life. Predictors of ICD deactivation were the occurrence of ICD deactivation discussions after implantation (OR 69.30, CI 26.45-181.59), DNR order (OR 6.83, CI 4.19-11.12), do-not-intubate order (OR 6.41, CI 3.75-10.96), and palliative care consultations (OR 8.67, CI 2.76-27.21). CONCLUSION ICD deactivation discussions and deactivation rates have increased since 2007. Nevertheless, ICDs remain active in the majority of patients at the end of life, some of whom experience shocks.
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Affiliation(s)
- Rik Stoevelaar
- 1 Department of Public Health, Erasmus University Medical Center Rotterdam, The Netherlands
| | | | - Anne Geert van Driel
- 2 Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.,3 Rotterdam University of Applied Sciences, The Netherlands
| | - Dominic Amj Theuns
- 4 Department of Cardiology, Erasmus University Medical Center Rotterdam, The Netherlands
| | - Rohit E Bhagwandien
- 4 Department of Cardiology, Erasmus University Medical Center Rotterdam, The Netherlands
| | | | - Ineke E Lokker
- 6 Department of Quality and Patient Care, Erasmus University Medical Center Rotterdam, The Netherlands
| | - Agnes van der Heide
- 1 Department of Public Health, Erasmus University Medical Center Rotterdam, The Netherlands
| | - Judith Ac Rietjens
- 1 Department of Public Health, Erasmus University Medical Center Rotterdam, The Netherlands
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