Incorporating the patient perspective: a critical review of clinical practice guidelines for implantable cardioverter defibrillator therapy
| Autor: | Richard Thomson, Kerry Joyce, Stephen R. Lord, Janet M. McComb, Daniel D. Matlock |
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| Rok vydání: | 2012 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Decision Making Risk Assessment Sudden cardiac death Patient-Centered Care Physiology (medical) medicine Humans Intensive care medicine Heart Failure business.industry Perspective (graphical) Critical factors Arrhythmias Cardiac medicine.disease Implantable cardioverter-defibrillator Patient preference Defibrillators Implantable Icd implantation Clinical Practice Death Sudden Cardiac Heart failure Practice Guidelines as Topic Quality of Life Physical therapy Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of Interventional Cardiac Electrophysiology. 36:185-197 |
| ISSN: | 1572-8595 1383-875X |
| Popis: | Implantable cardioverter defibrillators (ICDs) are recommended for patients with heart failure and/or ventricular arrhythmias at risk of sudden cardiac death. Guidelines for ICD implantation are derived from robust clinical data. However, critical factors which might influence treatment decisions include patient preferences. We set out to determine how clinical practice guidelines (CPGs) incorporate the patient perspective into supporting decision making about ICDs.CPGs on ICD implantation were purposively selected from national and professional bodies in Europe, North America and Australasia. CPGs were then appraised according to three key domains of shared decision making: (a) informing patients about the risks, benefits and consequences known to be important to patients; (b) personalising risks and benefits and (c) involvement of patient (plus family/significant others if desired) in decision making.Appraisal of six current CPGs found major deficiencies or inconsistencies in guidance. CPGs tended to focus on evidence of device effectiveness, with sparse consideration of other outcomes important to patients such as impacts on quality of life and psychosocial well-being. Little reference was made to involvement of the patient in decision making.This suggests that embedding shared decision in CPGs will improve the patient-centeredness of ICD treatment by enabling patients to make informed, value-based decisions. Specific recommendations for CPG development include the need for signposting to preference sensitive decision points as well as inclusion of a broader range of outcomes which are known to be important to patients when deciding whether or not to have a device fitted. |
| Databáze: | OpenAIRE |
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