Introduction: BHRS 2013 guidance on how to conduct a device follow up clinic states that an ICD clinic should aim ‘to provide patient and family support and education together with any other healthcare professionals involved in the patient’s management.’
We devised a three-stage ICD patient education programme. We tested the impact of this programme with a survey examining patient knowledge, psychological impact and satisfaction.
Method: Participants were recruited in two separate stages in a non-randomised format. Control patients were systematically given a two-page, 39-question survey immediately prior to outpatient device follow up clinic during November 2016. Patients had received education from consultation prior to implant; manufacturer-provided information booklets and post implant device check (only cardiac resynchronisation patients). The educational programme participants received, after their initial consultation, an invitation with family and carers to a group MDT pre-implant counselling session. At implant were given Barts information booklets, a ‘shock card’ prior to discharge, and a structured outpatient follow-up 1-month post implant. All patients who had completed their education programme at least 6 months prior were sent the survey via post. Patients who returned the survey via pre-paid postal delivery formed the education group.
The survey included 36 questions in a multiple-choice format and three with free-text responses. It was divided into four sections; demographics, satisfaction, ICD knowledge, and psychological impact.
Educational, psychological and satisfaction section scores were compared using a Mann-Whitney U-test. Individual questions were compared using a chi-square test.
Results:
Questionnaire results
Fifty-one patients were enrolled, 25 in the control group and 26 in the education group. The socio-demographics of patients are given in Table 1. A lower total educational score showed greater understanding; the education group showed a significant improvement in knowledge compared to baseline (Table 1). Within the education section, two questions showed significant improvements in understanding; what to do when a shock is received (Control: 1.8 ± 0.8 Education:
1.1 ± 0.39, X2 (2, n=51)= 6.3, p=0.01) and that the device can be switched off (Control: 2.2 ± 0.9 Education: 1.6 ± 0.8, X2 (2, n=51)
= 6.0, p=0.049).
A lower psychological score indicated a lower impact of psychological values and a higher satisfaction score indicated higher satisfaction. No significant difference was seen in either group.
Pre-implant counselling session satisfaction survey:
One-hundred-and-twenty-five patients attended the session between April 2018 and February 2019. The session satisfaction was rated good or excellent for 99% of participants and importantly 95% answered yes when asked if they felt more at ease. Forty-one percent of patients said they would like further support after this session.
Conclusion: A structured, multi-disciplinary educational programme significantly improves device knowledge. Further psychological support post implant maybe required to improve psychological impact and satisfaction. This utilises the expertise of each discipline to provide collaborative care that prepares vital knowledge for patients for their life with an ICD.
