(CCCNP002) EXPLORING THE THERAPEUTIC RELATIONSHIP WHEN PLANNING PATIENT DECISION AIDS USE THROUGHOUT THE IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR TRAJECTORY: A QUALITATIVE INVESTIGATION.

Background: Clinical practice guidelines endorse interventions to support shared decision-making such as patient decision aids (PDAs), for implantable cardioverter defibrillator (ICD) therapy decisions. Despite this, PDAs are not routinely used for ICD decisions. Patients facing ICD decisions continue to experience decisional conflict and report sub-optimal decision-making processes. Using PDAs in practice relies on a relational process between healthcare professionals including nurses and patients, but the influence of a therapeutic relationship on PDA use in any context has not been investigated.

Aim: The overarching aim of this study was to explore the influence of the therapeutic relationship and/or its elements when planning for PDA use for patients eligible for or with an ICD.

METHODS AND RESULTS: We conducted a secondary qualitative analysis using Thorne’s interpretive description approach. We thematically analyzed five individual interviews and four focus groups transcripts of patients with ICDs (n= 10), their family members (n= 3), nurses (n=6) and physicians (n= 11) from one ICD program at an academic hospital in Ontario, Canada. Themes were mapped onto the Ottawa Decision Support Framework (ODSF) and the therapeutic relationship elements as proposed by Browne (1993), Chalifour (1999), and Geller (2020).

Following preliminary analysis, we identified three main themes. Theme 1, Pieces of the relational puzzle: Elements of the therapeutic relationship, revealed that although participants did not mention the therapeutic relationship by name, they did identify two of its elements, respect and therapeutic communication, as important to PDA use. In Theme 2, Positive intentions towards the therapeutic relationship and inherent challenges, healthcare professionals described their good intentions – and challenges - for engaging patients in decision-making – which encompassed elements of the therapeutic relationship such as therapeutic communication, active listening, and respect. In Theme 3, PDA as a support to enhancing the therapeutic relationship, participants viewed the PDA as a vehicle to engage in a therapeutic relationship and apply its elements in clinical practice.

Conclusion:

Conclusion: Our findings provided insight on the importance of distinct elements of the therapeutic relationship on the use of PDAs. Hence, the importance of a therapeutic relationship should be considered when developing implementation strategies to facilitate PDA use in clinical practice. Theoretical implications include adding explicit details on the therapeutic relationship and its elements to existing frameworks, such as the ODSF, as a required competency and skill among nurses and other healthcare professionals when using decision support interventions.