Current Situation and Influencing Factors of Decision-Making Dilemma for Alternative Decision-Makers in ICD Implantation Therapy for Heart Failure Patients
Objective To investigate the current situation and influencing factors of decision-making dilemma among decision makers for implantable cardioverter defibrillator(ICD)implantation therapy in patients with heart failure.Methods ICD implantation treatment patients and their alternative decision-makers who visited a heart failure center at the First Affiliated Hospital of Zhengzhou University from April 2020 to March 2023 were selected as the survey subjects.Collected social demography data of patients and deputy decision-makers and data related to patients'diseases.Researchers filled out the simplified Chinese version of the Kansas city cardiomyopathy questionnaire(KCCQ)on behalf of patients.Substituted decision-makers fill out the decision dilemma scale,decision participation expectation scale,Vick forest physician trust scale,perceived social support scale,and state anxiety questionnaire.Exploring the correlation between state anxiety scores,Vick Forest physician trust scores,perceived social support scores,and the health status of heart failure patients with decision-making difficulties using correlation analysis.Exploring the relationship between demography characteristics and disease characteristics and decision-making dilemma.Exploring the influencing factors of decision-making difficulties using multiple linear regression analysis.Results A total of 148 patients with heart failure treated with ICD placement were included as substitute decision-makers,with a decision dilemma score of(36.03±8.79)points.There were 70.95％of substitute decision-makers scored 25 points,indicating the presence of decision difficulties.The results of univariate analysis showed that the influencing factors of decision-making difficulties included age,education level,marriage,monthly income,role of substitute decision-makers,relationship with patients,level of disease understanding,type of patient medical insurance,participation in decision-making,and duration of illness(P＜0.05).The correlation analysis results showed that the patient's health level(KCCQ score),anxiety level of substitute decision-makers,trust level in doctors,social support level were correlated with decision-making difficulties(P＜0.05).The results of multiple linear regression showed that the main factors contributing to decision-making difficulties include the anxiety level of substitute decision-makers,the level of trust in doctors,the level of social support,monthly income,and the duration of patient illness.Conclusion Most heart failure patients have decision-making difficulties in replacing decision makers with ICD implantation therapy.Medical staff should pay attention to the psychological characteristics of alternative decision-makers,mobilize their social support,adopt appropriate communication skills,and use decision aids if necessary when communicating with informed consent during ICD implantation surgery.
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