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Article

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

1
Department of Nursing, College of Nursing, Gachon University, 191 Hambakmoero, Yeonsugu, Incheon 21936, Korea
2
Department of Cardiovascular Medicine Chonnam National University Medical School, Chonnam National University Hospital, 42 Jebong-ro, Donggu, Gwangju 61469, Korea
3
Department of Nursing, College of Nursing, Chonnam National University, Chonnam National University Hospital, 160 Baekseoro, Donggu, Gwangju 61469, Korea
4
Department of Nursing, Dongguk University, 123 Dongdaero, Gyeongju-si, Gyeongsangbuk-do 38066, Korea
*
Authors to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(12), 4257; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17124257
Received: 9 April 2020 / Revised: 2 June 2020 / Accepted: 9 June 2020 / Published: 15 June 2020
(This article belongs to the Special Issue Nursing and Palliative Care)
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. View Full-Text
Keywords: implantable cardioverter-defibrillator; advance directive; advance care planning; perceived susceptibility; barriers/benefits implantable cardioverter-defibrillator; advance directive; advance care planning; perceived susceptibility; barriers/benefits
MDPI and ACS Style

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://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17124257

AMA Style

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://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17124257

Chicago/Turabian Style

Kim, JinShil, Hyung W. Park, Minjeong An, and Jae L. 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://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17124257

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