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首页> 外文期刊>PACE: Pacing and clinical electrophysiology >'It's not broke, so let's not try to fix it': Why patients decline a cardiovascular implantable electronic device
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'It's not broke, so let's not try to fix it': Why patients decline a cardiovascular implantable electronic device

机译：“它没有坏，所以我们不要尝试修复它”：为什么患者会拒绝使用心血管可植入电子设备

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Background Few patients decline therapy of a cardiovascular implantable electronic device (CIED), and little is known about the characteristics or reasoning of those who do. Our objective was to describe the reasons why patients decline CIED implantation using qualitative methods.Methods Qualitative, engaging thematic analysis. Three patient focus groups led by two trained facilitators and one semi-structured interview guide.Results Of the 13 patients, two were women and all were white (median age [range], 65 [44-88] years). Five themes emerged: (1) don't mess with a good thing; (2) my health is good enough; (3) independent decision making; (4) it's your job, but it's my choice; and (5) gaps in learning. Most patients who decline CIEDs are asymptomatic. Other reasons to decline included feeling well, enjoying life, acceptance of the future, desire to try to improve health through diet and exercise, hearing of negative CIED experiences, and unwillingness to take on associated risks of CIED implantation. A medical record review showed that clinicians understand patients' reasons for declining CIED treatment. However, focus group data suggest that gaps in patients' knowledge around the purpose and function of CIEDs exist and patients may benefit from targeted education.Conclusions Patients decline implantation of CIEDs for various reasons. Most patients who decline therapy are asymptomatic at the time of their device consult. Focus group information show data suggestive that device consultations should be enhanced to address gaps in patient learning and confirm knowledge transfer. Clinicians should revisit treatment options iteratively.
机译：背景技术很少有患者拒绝接受心血管可植入电子设备（CIED）的治疗，并且对这种患者的特征或推理知之甚少。我们的目的是使用定性方法描述患者拒绝CIED植入的原因。方法定性，参与主题分析。结果由三个训练有素的主持人和一个半结构化访谈向导领导的三个患者焦点小组。结果13例患者中，两名是女性，全部是白人（中位年龄[年龄]为65 [44-88]岁）。出现了五个主题：（1）别惹一件好事; （2）我的身体足够好; （三）独立决策; （4）这是你的工作，但这是我的选择; （5）学习差距。拒绝CIED的大多数患者无症状。下降的其他原因包括感觉良好，享受生活，对未来的接受，渴望通过饮食和运动来改善健康，听到负面的CIED经历以及不愿承担CIED植入带来的相关风险。病历回顾显示，临床医生了解患者拒绝CIED治疗的原因。然而，焦点小组的数据表明，患者对CIEDs的目的和功能的认识存在差距，患者可能会从有针对性的教育中受益。结论患者出于各种原因而拒绝植入CIEDs。大多数拒绝接受治疗的患者在咨询设备时都没有症状。焦点小组信息显示的数据表明，应加强设备咨询以解决患者学习方面的空白并确认知识转移。临床医生应迭代地重新选择治疗方案。

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