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J Cardiovasc Nurs. 2009 May-Jun;24(3):225-31. doi: 10.1097/JCN.0b013e31819c143d.

Patient-assisted computerized education for recipients of implantable cardioverter defibrillators: a randomized controlled trial of the PACER program.

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  • 1American Psychiatric Institute for Research and Education, Division of Research, American Psychiatric Association, Arlington, Virginia 22209, USA. eakuhl@gmail.com

Abstract

BACKGROUND AND RESEARCH OBJECTIVE:

Patients with implantable cardioverter defibrillators (ICDs) are at risk for postimplant anxiety. Computerized treatments for anxiety are well supported and desirable because of accessibility, anonymity, and cost-effectiveness. However, there currently exists no computerized psychosocial treatment for ICD populations. Our objective was to evaluate whether a pilot program (patient-assisted computerized education for recipients of ICDs [PACER of ICDs]) of a computerized intervention for ICD patients would improve ICD-related knowledge and psychological outcomes versus usual care. Outcomes were also compared with those from a related study that used the same intervention but in an in-person format.

SUBJECTS AND METHODS:

Patients (N = 30) with an ICD were randomized to PACER or usual care. Mean time from implantation was 10.71 months (SD, 21.81 months). Outcomes included ICD-related knowledge, trait anxiety, defibrillation-related anxiety, patient acceptance of the ICD, and quality of life. Patients were assessed at baseline and at 1 month follow-up.

RESULTS AND CONCLUSIONS:

Knowledge score over time did not differ by treatment group, although both groups improved their scores. Among treatment patients, increased knowledge accounted for a significant amount of variance in device acceptance (R2 change = 0.30, P =.02), irrespective of age, education, ejection fraction, and time from implantation. There was no relationship between knowledge and device acceptance among control patients. Compared with previous recipients, new device recipients (< 3 months) were more likely to demonstrate an increase in knowledge (P =.01), greater defibrillation anxiety (P =.02), and worse patient acceptance (P =.04). Patient-assisted computerized education for recipients of ICDs resulted in comparable improvements in trait anxiety, quality of life, and device acceptance as the in-person treatment. The potential utility of PACER to enhance device acceptance lends support for further testing among larger samples.

PMID:
19390340
DOI:
10.1097/JCN.0b013e31819c143d
[PubMed - indexed for MEDLINE]
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