Adult Patient Decision-making Regarding Implantation Of Complex Cardiac Devices: A Scoping Review

Background: Complex cardiac rhythm management device (CRMD) therapy provides an important treatment option for people at risk of sudden cardiac death (SCD). Despite the survival benefit, device implantation is associated with significant physical and psychosocial concerns presenting considerable challenges for the decision-making process surrounding CRMD implantation for patients and physicians. Aims: The purpose of this scoping review was to explore what is known about how adult (>16 years) patients make decisions regarding implantation of CRMD therapy. Methods: Published, peer-reviewed, English-language studies from 2000 to 2016 were identified in a search across eight healthcare databases. Eligible studies were concerned with patient decision-making for first time device implantation. Quality assessment was completed using the Mixed Methods Appraisal Tool (MMAT) for all studies meeting the inclusion criteria. Results: The findings of 8 qualitative and 7 quantitative studies, including patients who accepted or declined primary or secondary SCD prevention devices, were clustered in to two themes; knowledge acquisition and the process of decision-making, exposing similarities and distinctions with the treatment decision-making literature. Conclusion: The review revealed some insight in to the way patients approach decision-making but also exposed a lack of clarity and research activity specific to CRMD patients. Further research is recommended to support the development and application of targeted decision support mechanisms.