Patient-Assisted Computerized Education for Recipients of Implantable Cardioverter Defibrillators A Randomized Controlled Trial of the PACER Program
Patient-Assisted Computerized Education for Recipients of Implantable Cardioverter Defibrillators A Randomized Controlled Trial of the PACER Program
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DOI：
10.1097/jcn.0b013e31819c143d
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发表时间：
2009-05-01
影响因子：
2
通讯作者：
Conti, Jamie B.
中科院分区：
文献类型：
--
作者：
Kuhl, Emily A.;Sears, Samuel F.;Conti, Jamie B.
背景和研究目的：植入心脏复律除颤器（ICD）的患者存在植入后焦虑的风险。焦虑的计算机化治疗得到了很好的支持和期望，因为可访问性，匿名性和成本效益。然而，目前还没有针对ICD人群的计算机化心理社会治疗。我们的目的是评价与常规护理相比，ICD患者计算机化干预的试点项目（ICD接受者的患者辅助计算机化教育[ICD的PACER]）是否会改善ICD相关知识和心理结局。还将结局与使用相同干预但以面对面形式进行的相关研究的结局进行了比较。受试者和方法：植入ICD的患者（N = 30）随机接受PACER或常规治疗。自植入的平均时间为10.71个月（SD，21.81个月）。结果包括ICD相关知识、特质焦虑、除颤相关焦虑、患者对ICD的接受程度和生活质量。在基线和1个月随访时对患者进行评估，结果和结论：治疗组的知识评分随时间推移没有差异，尽管两组的评分均有所改善。在接受治疗的患者中，知识的增加解释了器械接受性的显著差异（R（2）变化= 0.30，P = 0.02），与年龄、教育、射血分数和植入时间无关。在对照组患者中，知识和器械接受度之间没有关系。与之前的接受者相比，新器械接受者（< 3个月）更有可能表现出知识的增加（P = .01），更大的除颤焦虑（P = .02）和更差的患者接受度（P = .04）。ICD接受者的患者辅助计算机化教育导致特质焦虑、生活质量和设备接受度的改善与面对面治疗相当。PACER增强器械可接受性的潜在效用支持在更大样本中进行进一步测试。
Background and Research Objective: Patients with implantable cardioverter defibrillators (ICDs) are at risk for postimplant anxiety. Computerized treatments for anxiety are well supported and desirable because of accessibility, anonymity, and cost-effectiveness. However, there currently exists no computerized psychosocial treatment for ICD populations. Our objective was to evaluate whether a pilot program (patient-assisted computerized education for recipients of ICDs [PACER of ICDs]) of a computerized intervention for ICD patients would improve ICD-related knowledge and psychological outcomes versus usual care. Outcomes were also compared with those from a related study that used the same intervention but in an in-person format, Subjects and Methods: Patients (N = 30) with an ICD were randomized to PACER or usual care. Mean time from implantation was 10.71 months (SD, 21.81 months). Outcomes included ICD-related knowledge, trait anxiety, defibrillation-related anxiety, patient acceptance of the ICD, and quality of life. Patients were assessed at baseline and at 1 month follow-up, Results and Conclusions: Knowledge score over time did not differ by treatment group, although both groups improved their scores. Among treatment patients, increased knowledge accounted for a significant amount of variance in device acceptance (R(2) change = 0.30, P = .02), irrespective of age, education, ejection fraction, and time from implantation. There was no relationship between knowledge and device acceptance among control patients. Compared with previous recipients, new device recipients (< 3 months) were more likely to demonstrate an increase in knowledge (P = .01), greater defibrillation anxiety (P = .02), and worse patient acceptance (P = .04). Patient-assisted computerized education for recipients of ICDs resulted in comparable improvements in trait anxiety, quality of life, and device acceptance as the in-person treatment. The potential utility of PACER to enhance device acceptance lends support for further testing among larger samples.