The implantable cardioverter defibrillator (ICD) is a small medical device, implanted underneath the collarbone with wires leading from it to the heart. The device detects and terminates ventricular arrhythmias by delivering an electric shock, that otherwise would most likely lead to sudden cardiac arrest and sudden cardiac death. The ICD is perceived as the 'gold standard' treatment therapy for patients at risk of sudden cardiac death resulting from fast electrical rhythms (Bleasdale, Ruskin, O'Callaghan, 2005). However, ICD recipients have reported high levels of psychological distress such as anxiety and depression and a reduced quality of life (e.g. clinical review by Sears, Matchett & Conti, 2009). This thesis describes the development of a brief psychological intervention for patients living with an ICD based on the Medical Research Council's (2008) guidelines. The first stage in the development of the intervention was a qualitative study. Thirtysix ICD participants (ICD patients and partner) were recruited in south Wales. Semistructured interviews were conducted with each participant separately. Thirteen of the patients had not experienced an ICD shock. Transcripts were analysed by thematic analysis (Braun and Clarke, 2006) using a cognitive-emotional-coping framework. General findings revealed patients did not know how to regain normality after their ICD and highlighted common worries were identified. Accordingly, the intervention aimed to be a structured guide underpinned by cognitive behavioural theory. It aimed to address common worries and bridge the gap between hospital discharge and patient's 6-week follow up appointment. The intervention was tested using a pilot randomised control trial. Ninety-nine participants were randomised to an intervention or control group. Differences between groups at baseline were adjusted by analysis of covariance (ANCOVA) to control for differences at 3- and 6-months. Results revealed the intervention group reported improved levels of depression, increased levels of mild exercise and increased patient acceptance to the ICD compared to the control group at 6-months. The simplicity and cost-effectiveness of this intervention suggests that not only is it theory and evidenced based, but should be sustainable long term. The next stage would be to carry out a fully powered randomised control trial.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:678593 |
| Date | January 2014 |
| Creators | Humphreys, Nina Kumari |
| Publisher | Swansea University |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | https://cronfa.swan.ac.uk/Record/cronfa43026 |
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