Exploring Advance Directive Perspectives and Associations with Preferences for End-of-Life Life-Sustaining Treatments among Patients with Implantable Cardioverter-Defibrillators
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design and Procedure
2.2. Subjects
2.3. Measures
2.4. Statistical Analysis
3. Results
3.1. End-of-Life Values and Treatment Wishes
3.2. Differences in Perceived Susceptibility, and Barriers and Benefits According to Treatment Preferences
3.3. Predictive Values of Perceived Susceptibility and Barriers/Benefits for End-of-life Treatment Preferences
4. Discussion
4.1. Implications for Research and Practice
4.2. Limitations
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Variables | n (%) | Mean ± SD | Range | |
---|---|---|---|---|
Age, years | 50.1 ± 0.94 | 29.0–73.0 | ||
Sex | Male | 41 (85.4) | ||
Marital status | Married | 42 (87.5) | ||
Education | ≤Middle school | 6 (12.5) | ||
High school | 23 (47.9) | |||
≥College | 17 (35.4) | |||
NYHA classes | I | 40 (83.3) | ||
II | 8 (16.7) | |||
III/IV | 0 (0.0) | |||
ICD indication | Primary | 6 (12.5) | ||
Secondary | 42 (87.5) | |||
Underlying cardiac diseases | Ventricular arrhythmias | 39 (81.3) | ||
Brugada syndrome | 3 (6.2) | |||
Non-ICM | 3 (6.2) | |||
ICM | 2 (4.2) | |||
DCM | 1 (2.1) | |||
Multicomorbidity | 0–1 | 37 (77.1) | ||
≧2 | 11 (22.9) | |||
ADs awareness | Yes | 10 (20.8) | ||
Median (Q1–Q3) | ||||
LVEF (%) | 62.7 (47.2–67.4) | |||
Post-ICD duration (months) | 30.0 (13.0–63.5) |
Value statements (N = 44) | n (%) | |
---|---|---|
No burden on family including children | 26 (59.1) | |
Comfortable death during end of life | 9 (20.4) | |
Dying comfortably without burden on family | 5 (11.4) | |
Being buried after death | 2 (4.5) | |
Never thought about it | 1 (2.3) | |
Having a quiet funeral | 1 (2.3) | |
Treatment wishes † | Cardiopulmonary resuscitation (Yes) | Treatment wishes † |
(N = 48) | Ventilator support (Yes) | (N = 48) |
Hemodialysis (Yes) | ||
Hospice care (Yes) |
Variables | CPR Mean (±SD) | t (p) | Ventilator Support Mean (±SD) | t (p) | Hemodialysis Mean (±SD) | t (p) | Hospice Mean (±SD) | t (p) | ||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Yes (n = 26) | No (n = 22) | Yes (n = 21) | No (n = 27) | Yes (n = 22) | No (n = 26) | Yes (n = 22) | No (n = 26) | |||||
Perceived susceptibility | 24.46 (±6.62) | 19.59 (±7.18) | 2.44 (0.019) | 25.19 (±6.98) | 19.92 (±6.68) | 2.66 (0.011) | 25.27 (±6.74) | 19.65 (±6.73) | 2.88 (0.006) | 23.95 (±7.36) | 21.61 (±7.22) | 0.64 (0.529) |
Perceived Barriers | 35.65 (±11.61) | 27.54 (±13.70) | 2.22 (0.031) | 35.28 (±12.77) | 29.33 (±13.03) | 1.58 (0.120) | 36.59 (±11.00) | 28.00 (±13.68) | 2.37 (0.022) | 33.04 (±10.89) | 31.00 (±14.92) | 0.53 (0.596) |
Perceived Benefits | 34.00 (±7.37) | 31.09 (±10.06) | 1.15 (0.255) | 34.23 (±7.34) | 31.44 (±9.64) | 1.10 (0.276) | 33.9 (±7.7) | 31.65 (±9.56) | 0.87 (0.388) | 33.27 (±8.03) | 32.15 (±9.42) | 0.44 (0.663) |
Outcome Variable | Factor | B | p | OR | 95% CI | |
---|---|---|---|---|---|---|
Lower | Upper | |||||
Cardiopulmonary | Constants | −4.83 | 0.132 | 0.01 | ||
resuscitation | Perceived susceptibility | 0.14 | 0.043 | 1.15 | 1.004 | 1.311 |
Hosmer and Lemeshow’s Goodness-of-Fit test: χ2 = 3.58, p = 0.893; Nagelkerke R2 = 0.415 | ||||||
Ventilator | Constants | −2.78 | 0.343 | 0.06 | ||
support | Perceived susceptibility | 0.16 | 0.020 | 1.17 | 1.025 | 1.337 |
Hosmer and Lemeshow’s Goodness-of-Fit test: χ2 = 14.94, p = 0.060; Nagelkerke R2 = 0.320 | ||||||
Hemodialysis | Constants | −3.06 | 0.361 | 0.05 | ||
Sex (female) | −2.92 | 0.042 | 0.05 | 0.003 | 0.897 | |
Perceived susceptibility | 0.20 | 0.010 | 1.23 | 1.049 | 1.430 | |
Hosmer and Lemeshow’s Goodness-of-Fit test: χ2 = 8.42, p = 0.394; Nagelkerke R2 = 0.485 | ||||||
Hospice care | Constants | −2.32 | 0.432 | 0.10 | ||
Age | 0.09 | 0.016 | 1.09 | 1.017 | 1.178 | |
Hosmer and Lemeshow’s Goodness-of-Fit test: χ2 = 6.74, p = 0.565; Nagelkerke R2 = 0.383 |
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Kim, J.; Park, H.W.; An, M.; Shim, J.L. Exploring Advance Directive Perspectives and Associations with Preferences for End-of-Life Life-Sustaining Treatments among Patients with Implantable Cardioverter-Defibrillators. Int. J. Environ. Res. Public Health 2020, 17, 4257. https://doi.org/10.3390/ijerph17124257
Kim J, Park HW, An M, Shim JL. Exploring Advance Directive Perspectives and Associations with Preferences for End-of-Life Life-Sustaining Treatments among Patients with Implantable Cardioverter-Defibrillators. International Journal of Environmental Research and Public Health. 2020; 17(12):4257. https://doi.org/10.3390/ijerph17124257
Chicago/Turabian StyleKim, JinShil, Hyung Wook Park, Minjeong An, and Jae Lan Shim. 2020. "Exploring Advance Directive Perspectives and Associations with Preferences for End-of-Life Life-Sustaining Treatments among Patients with Implantable Cardioverter-Defibrillators" International Journal of Environmental Research and Public Health 17, no. 12: 4257. https://doi.org/10.3390/ijerph17124257