A study to improve communication between clinicians and patients with advanced heart failure

Methods and challenges behind the working to improve discussions about defibrillator management trial

Nathan E. Goldstein, Jill Kalman, Jean S. Kutner, Erik Fromme, Mathew D. Hutchinson, Hannah I. Lipman, Daniel D. Matlock, Keith M. Swetz, Rachel Lampert, Omarys Herasme, R. Sean Morrison

    Research output: Contribution to journalArticle

    19 Citations (Scopus)

    Abstract

    We report the challenges of the Working to Improve Discussions About Defibrillator Management trial, our novel, multicenter trial aimed at improving communication between cardiology clinicians and their patients with advanced heart failure (HF) who have implantable cardioverter defibrillators (ICDs). The study objectives are (1) to increase ICD deactivation conversations, (2) to increase the number of ICDs deactivated, and (3) to improve psychological outcomes in bereaved caregivers. The unit of randomization is the hospital, the intervention is aimed at HF clinicians, and the patient and caregiver are the units of analysis. Three hospitals were randomized to usual care and three to intervention. The intervention consists of an interactive educational session, clinician reminders, and individualized feedback. We enroll patients with advanced HF and their caregivers, and then we regularly survey them to evaluate whether the intervention has improved communication between them and their HF providers. We encountered three implementation barriers. First, there were institutional review board concerns at two sites because of the palliative nature of the study. Second, we had difficulty in creating entry criteria that accurately identified an HF population at high risk of dying. Third, we had to adapt our entry criteria to the changing landscape of ventricular assist devices and cardiac transplant eligibility. Here we present our novel solutions to the difficulties we encountered. Our work has the ability to enhance conduct of future studies focusing on improving care for patients with advanced illness.

    Original languageEnglish (US)
    Pages (from-to)1236-1246
    Number of pages11
    JournalJournal of Pain and Symptom Management
    Volume48
    Issue number6
    DOIs
    StatePublished - Dec 1 2014

    Fingerprint

    Defibrillators
    Heart Failure
    Communication
    Implantable Defibrillators
    Caregivers
    Heart-Assist Devices
    Aptitude
    Research Ethics Committees
    Random Allocation
    Cardiology
    Multicenter Studies
    Patient Care
    Psychology
    Transplants

    Keywords

    • communication
    • Heart failure
    • intervention
    • IRB
    • methods
    • palliative care
    • randomized controlled trial

    ASJC Scopus subject areas

    • Anesthesiology and Pain Medicine
    • Clinical Neurology
    • Nursing(all)

    Cite this

    A study to improve communication between clinicians and patients with advanced heart failure : Methods and challenges behind the working to improve discussions about defibrillator management trial. / Goldstein, Nathan E.; Kalman, Jill; Kutner, Jean S.; Fromme, Erik; Hutchinson, Mathew D.; Lipman, Hannah I.; Matlock, Daniel D.; Swetz, Keith M.; Lampert, Rachel; Herasme, Omarys; Sean Morrison, R.

    In: Journal of Pain and Symptom Management, Vol. 48, No. 6, 01.12.2014, p. 1236-1246.

    Research output: Contribution to journalArticle

    Goldstein, Nathan E. ; Kalman, Jill ; Kutner, Jean S. ; Fromme, Erik ; Hutchinson, Mathew D. ; Lipman, Hannah I. ; Matlock, Daniel D. ; Swetz, Keith M. ; Lampert, Rachel ; Herasme, Omarys ; Sean Morrison, R. / A study to improve communication between clinicians and patients with advanced heart failure : Methods and challenges behind the working to improve discussions about defibrillator management trial. In: Journal of Pain and Symptom Management. 2014 ; Vol. 48, No. 6. pp. 1236-1246.
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