Ian B Kwok1, Harriet Mather2, Karen McKendrick2, Laura Gelfman2,3, Mathew D Hutchinson4, Rachel J Lampert5, Hannah I Lipman6,7, Daniel D Matlock8,9, Keith M Swetz10, Jill Kalman11, Sean Pinney12, R Sean Morrison2,3, Nathan E Goldstein2,3. 1. Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel Hospital, New York, New York, USA. 2. Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA. 3. Geriatrics Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA. 4. Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona College of Medicine Tucson, Tucson, Arizona, USA. 5. Department of Internal Medicine, Section of Cardiology, Yale University School of Medicine, New Haven, Connecticut, USA. 6. Department of Internal Medicine, Hackensack Meridian School of Medicine at Seton Hall University, Nutley, New Jersey, USA. 7. Center for Bioethics, Hackensack University Medical Center, Hackensack, New Jersey, USA. 8. Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA. 9. VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, Colorado, USA. 10. Birmingham Veterans Affairs Medical Center, Department of Medicine and UAB Center for Palliative and Supportive Care, University of Alabama Birmingham, Birmingham, Alabama, USA. 11. Lenox Hill Hospital, Northwell Health, New York, New York, USA. 12. Division of Cardiology, Samuel Bronfman Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Abstract
Background: Implantable cardioverter-defibrillators (ICDs) reduce the incidence of sudden cardiac death for high-risk patients with heart failure (HF), but shocks from these devices can also cause pain and anxiety at the end of life. Although professional society recommendations encourage proactive discussions about ICD deactivation, clinicians lack training in conducting these conversations, and they occur infrequently. Methods: As part of a six-center randomized controlled trial, we evaluated the educational component of a multicomponent intervention shown to increase conversations about ICD deactivation by clinicians who care for a subset of patients with advanced HF. This consisted of a 90-minute training workshop designed to improve the quality and frequency of conversations about ICD management. To characterize its utility as an isolated intervention, we compared HF clinicians' pre- and postworkshop scores (on a 5-point Likert scale) assessing self-reported confidence and skills in specific practices of advance care planning, ICD deactivation discussions, and empathic communication. Results: Forty intervention-group HF clinicians completed both pre- and postworkshop surveys. Preworkshop scores showed high baseline levels of confidence (4.36, standard deviation [SD] = 0.70) and skill (4.08, SD = 0.72), whereas comparisons of pre- and postworkshop scores showed nonsignificant decreases in confidence (-1.16, p = 0.252) and skill (-0.20, p = 0.843) after the training session. Conclusions: Our findings showed no significant changes in self-assessment ratings immediately after the educational intervention. However, our data did demonstrate that HF clinicians had high baseline self-perceptions of their skills in advance care planning conversations and appear to be well-primed for further professional development to improve communication in the setting of advanced HF.
RCT Entities:
Background: Implantable cardioverter-defibrillators (ICDs) reduce the incidence of sudden cardiac death for high-risk patients with heart failure (HF), but shocks from these devices can also cause pain and anxiety at the end of life. Although professional society recommendations encourage proactive discussions about ICD deactivation, clinicians lack training in conducting these conversations, and they occur infrequently. Methods: As part of a six-center randomized controlled trial, we evaluated the educational component of a multicomponent intervention shown to increase conversations about ICD deactivation by clinicians who care for a subset of patients with advanced HF. This consisted of a 90-minute training workshop designed to improve the quality and frequency of conversations about ICD management. To characterize its utility as an isolated intervention, we compared HF clinicians' pre- and postworkshop scores (on a 5-point Likert scale) assessing self-reported confidence and skills in specific practices of advance care planning, ICD deactivation discussions, and empathic communication. Results: Forty intervention-group HF clinicians completed both pre- and postworkshop surveys. Preworkshop scores showed high baseline levels of confidence (4.36, standard deviation [SD] = 0.70) and skill (4.08, SD = 0.72), whereas comparisons of pre- and postworkshop scores showed nonsignificant decreases in confidence (-1.16, p = 0.252) and skill (-0.20, p = 0.843) after the training session. Conclusions: Our findings showed no significant changes in self-assessment ratings immediately after the educational intervention. However, our data did demonstrate that HF clinicians had high baseline self-perceptions of their skills in advance care planning conversations and appear to be well-primed for further professional development to improve communication in the setting of advanced HF.
Authors: Nathan E Goldstein; Harriet Mather; Karen McKendrick; Laura P Gelfman; Mathew D Hutchinson; Rachel Lampert; Hannah I Lipman; Daniel D Matlock; Jacob J Strand; Keith M Swetz; Jill Kalman; Jean S Kutner; Sean Pinney; R Sean Morrison Journal: J Am Coll Cardiol Date: 2019-10-01 Impact factor: 24.094
Authors: Arthur J Moss; Wojciech Zareba; W Jackson Hall; Helmut Klein; David J Wilber; David S Cannom; James P Daubert; Steven L Higgins; Mary W Brown; Mark L Andrews Journal: N Engl J Med Date: 2002-03-19 Impact factor: 91.245
Authors: Mark S Kremers; Stephen C Hammill; Charles I Berul; Christina Koutras; Jeptha S Curtis; Yongfei Wang; Jim Beachy; Laura Blum Meisnere; Del M Conyers; Matthew R Reynolds; Paul A Heidenreich; Sana M Al-Khatib; Ileana L Pina; Kathleen Blake; Mary Norine Walsh; Bruce L Wilkoff; Alaa Shalaby; Frederick A Masoudi; John Rumsfeld Journal: Heart Rhythm Date: 2013-02-09 Impact factor: 6.343
Authors: Anthony L Back; Robert M Arnold; Walter F Baile; Kelly A Fryer-Edwards; Stewart C Alexander; Gwyn E Barley; Ted A Gooley; James A Tulsky Journal: Arch Intern Med Date: 2007-03-12
Authors: Tiny Jaarsma; James M Beattie; Mary Ryder; Frans H Rutten; Theresa McDonagh; Paul Mohacsi; Scott A Murray; Thomas Grodzicki; Ingrid Bergh; Marco Metra; Inger Ekman; Christiane Angermann; Marcia Leventhal; Antonis Pitsis; Stefan D Anker; Antonello Gavazzi; Piotr Ponikowski; Kenneth Dickstein; Etienne Delacretaz; Lynda Blue; Florian Strasser; John McMurray Journal: Eur J Heart Fail Date: 2009-05 Impact factor: 15.534