Experiences Implementing a Suite of Decision Aids for Implantable Cardioverter Defibrillators: Qualitative Insights From the DECIDE-ICD Trial.
Experiences Implementing a Suite of Decision Aids for Implantable Cardioverter Defibrillators: Qualitative Insights From the DECIDE-ICD Trial.
复制标题
DOI：
10.1161/circoutcomes.122.009352
复制
发表时间：
2022-11
影响因子：
6.9
通讯作者：
Matlock, Daniel D.
中科院分区：
文献类型：
--
作者：
Knoepke, Christopher E.;Wallace, Bryan C.;Allen, Larry A.;Lewis, Carmen L.;Gupta, Sanjaya K.;Peterson, Pamela N.;Kramer, Daniel B.;Brancato, Scott C.;Varosy, Paul D.;Mandrola, John M.;Tzou, Wendy S.;Matlock, Daniel D.
共享决策 (SDM) 在心脏病学中变得越来越重要，包括 CMS 报销政策，要求为考虑一级预防植入式心律转复除颤器 (ICD) 的患者提供记录的 SDM。 DECIDE-ICD 试验在七个地点使用阶梯楔形设计评估了患者决策辅助 (DA) 的实施和有效性。该子分析的目的是定性描述电生理学 (EP) 临床医生实施和使用 DA 的经验。在转入试验实施阶段（2020 年 6 月至 2022 年 2 月）至少六个月后，对美国各地参与地点的电生理学临床医生进行半结构化个人访谈。访谈指南根据 RE-AIM 框架构建，评估可能影响实施领域的临床医生经验，并使用混合归纳/演绎方法进行定性评估。我们在所有七个站点完成了 22 次实施后访谈。参与者包括医生 (n=16) 和其他为患者提供治疗选择咨询的临床医生 (n=6)。虽然对 SDM 和 DA 的看法是积极的，但参与者强调了 DA 向适当患者的交付不均匀的原因。 SDM 的 CMS 要求并不被普遍视为与接受 DA 的患者相关，而是 1) DA 交付的后勤工作，2) 改善患者决策的感知有效性，3) DA 内容与当前患者群体的匹配。剩下的紧张局势包括 DA 中使用的具体试验数据以及协调交付时间与患者积极做出决定的时间。负责向考虑使用一级预防 ICD 的患者提供 DA 的临床医生普遍支持 SDM 的原则以及 DA 工具本身，但指出了在常规护理中扩大其覆盖范围和继续使用它们的一些机会。 ClinicalTrials.gov 标识符：NCT03374891 https://clinicaltrials.gov/ct2/show/NCT03374891
Shared decision making (SDM) is gaining importance in cardiology, including CMS reimbursement policies requiring documented SDM for patients considering primary prevention implantable cardioverter defibrillators (ICD). The DECIDE-ICD Trial assessed the implementation and effectiveness of patient decision aids (DAs) using a stepped-wedge design at seven sites. The purpose of this sub-analysis was to qualitatively describe electrophysiology (EP) clinicians’ experience implementing and using the DAs. Semi-structured individual interviews with electrophysiology clinicians at participating sites across the U.S., at least six months following conversion into the implementation phase of the trial (June 2020-Feb 2022). The interview guide was structured according to the RE-AIM framework, assessing clinician experiences which can impact implementation domains, and was qualitatively assessed using a mixed inductive/deductive method. We completed 22 interviews post-implementation across all seven sites. Participants included both physicians (n= 16) and other clinicians who counsel patients regarding treatment options (n=6). While perception of SDM and the DA were positive, participants highlighted reasons for uneven delivery of DAs to appropriate patients. The CMS mandate for SDM was not universally viewed as associating with patients receiving DA’s, but rather 1) logistics of DA delivery, 2) perceived effectiveness in improving patient decision-making, 3) match of DA content to current patient populations. Remaining tensions include the specific trial data used in DAs and reconciling timing of delivery with when patients are actively making decisions. Clinicians charged with delivering DAs to patients considering primary prevention ICDs were generally supportive of the tenets of SDM, and of the DA tools themselves, but noted several opportunities to improve the reach and continued use of them in routine care. ClinicalTrials.gov Identifier: NCT03374891 https://clinicaltrials.gov/ct2/show/NCT03374891