Bridging a practice gap in patient education on end-of-life defibrillator management: A quality improvement initiative

BACKGROUND: When patients with an implantable cardioverter-defibrillator (ICD) near the end-of-life (EOL), shock therapy from the device can cause unnecessary suffering. Professional guidelines recommend timely discussions on the shock deactivation option with ICD recipients. LOCAL PROBLEM: At the project site, many older patients with serious illnesses have shock therapy active in their ICDs. This project aimed to improve ICD recipients' knowledge, attitudes, and decision making regarding EOL device management options by providing guideline-recommended patient education. METHODS: Single-site, quality improvement project employing pre/post survey design among ICD recipients in the outpatient setting. The Experiences, Attitudes, and Knowledge of End-of-Life Issues in ICD Questionnaire was used for the survey. INTERVENTIONS: The key intervention was a structured patient education session (SPES) in the device clinic led by a cardiac electrophysiology nurse practitioner. RESULTS: Of the 90 participants, 94.4% were ≥60 years old and 95.6% were males. After the SPES, the responses to all ICD knowledge items showed significant positive differences based on the McNemar test significance ( p ≤ .001). Responses to five attitude items on EOL ICD discussions/actions also showed significant positive changes after the education with McNemar Test significance