Exploring Advance Directive Perspectives and Associations with Preferences for End-of-Life Life-Sustaining Treatments among Patients with Implantable Cardioverter-Defibrillators

JinShil Kim, Hyung Wook Park, Minjeong An and Jae Lan Shim
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JinShil Kim: Department of Nursing, College of Nursing, Gachon University, 191 Hambakmoero, Yeonsugu, Incheon 21936, Korea
Hyung Wook Park: Department of Cardiovascular Medicine Chonnam National University Medical School, Chonnam National University Hospital, 42 Jebong-ro, Donggu, Gwangju 61469, Korea
Minjeong An: Department of Nursing, College of Nursing, Chonnam National University, Chonnam National University Hospital, 160 Baekseoro, Donggu, Gwangju 61469, Korea
Jae Lan Shim: Department of Nursing, Dongguk University, 123 Dongdaero, Gyeongju-si, Gyeongsangbuk-do 38066, Korea

IJERPH, 2020, vol. 17, issue 12, 1-11

Abstract: Deactivation of an implantable cardioverter-defibrillator (ICD) is a critical issue in the advance care planning (ACP) of ICD recipients; however, related perspectives have rarely been explored. Thus, this study aimed to provide an initial investigation of ICD recipients’ perceived susceptibility and barriers/benefits regarding ACP and/or advance directives (ADs), and associations of these modifiable factors with preferences for end-of-life life-sustaining treatments (LSTs) (cardiopulmonary resuscitation (CPR), ventilator support, hemodialysis, and hospice care). Using a descriptive correlational design, 48 ICD recipients (age, 50.1 years; male, 85.4%) completed survey questionnaires. “No burden on family” was the most highly valued (59.1%), followed by “comfortable death” (20.4%), and both (11.4%). LST preference was 43.8% for ventilator support, 45.8% for both hemodialysis and hospice care, and 54.2% for CPR. Perceived susceptibility to having unexpected end-of-life experiences increased the likelihood of preference for aggressive LSTs, with preferences increasing by 15% for CPR, 17% for ventilator support, and 23% for hemodialysis. A non-modifiable factor, older age, was the only predictor of increased preference for hospice care (odds ratio = 1.09, p = 0.016). Among the modifiable factors, a higher perceived susceptibility increased the likelihood of aggressive LST preferences. The findings imply that to facilitate informed decisions for LSTs, early ACP discussion could be helpful and enhance these modifiable factors.

Keywords: implantable cardioverter-defibrillator; advance directive; advance care planning; perceived susceptibility; barriers/benefits (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
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