An ICD is an electrical device that aims to treat life-threatening heart rhythms by delivering an electrical shock, also known as defibrillation, to restore a person's healthy heartbeat. The pioneering research, which was conducted at Ulster University, focuses on patients', healthcare professionals' and carers' involvement in ICD deactivation during the advanced stages of heart failure.
ICDs are surgically implanted to prolong a patient's life, however their role is contentious when patients become terminal ill. In such cases it may be appropriate to deactivate, or turn off, the shock function of the device. This aims to spare the patient and their family the trauma of futile shock treatment and allow a more natural death.
The Ulster University research found that many patients have limited understanding of the ICD and insufficient knowledge of its purpose. This can diminish the choices they have at end of life and restrict their ability to be involved in the decisions around deactivation. It also discovered that carers wanted more involvement with healthcare professionals when it comes to their loved one's advanced care plan.
The research surveyed doctors, nurses and physiologists internationally and found a general reluctance by professionals to discuss ICD deactivation with patients for fear of causing anxiety. It found that length of time in post and a previous experience of discussing deactivation were mostly likely to impact professionals' confidence to initiate the conversation.
Speaking about her PhD research, specialist cardiac nurse at the Belfast Trust, Loreena Hill, said: "International clinical guidelines recommend patients are informed about the possibility of deactivation prior to implantation of the ICD. However, our research found that all too often the discussion about deactivation took place in the final days or hours before death, with patients and their families deprived of valuable advanced preparation.
"This Ulster University study has highlighted the need for improved information prior to ICD implantation and tailored discussions regarding deactivation with both patients and carers. Further research into innovative strategies to successfully implement the findings within clinical practice is urgently required.
"My PhD research has been published in high impact journals including the European journals of Cardiovascular Nursing and Palliative Medicine. I have also presented the research at many international healthcare conferences, with the next being the European Society of Cardiology (ESC) congress, the world's leading congress for experts in cardiology.
"I feel very privileged to have been appointed a Nurse Fellow of the ESC in 2015 and earlier this month I was elected onto the Board of the Heart Failure Association of the ESC. I look forward to playing a more active role in improving the care of heart failure patients across the globe."