Date of Award

1-1-2015

Document Type

Dissertation

Degree Name

Ph.D.

Organizational Unit

Graduate School of Social Work

First Advisor

Jeffrey M. Jenson, Ph.D.

Second Advisor

Leslie Hasche

Third Advisor

Jennifer C. Greenfield

Fourth Advisor

Daniel Matlock

Keywords

Health communication, Implanted defibrillator, Medical social work, Patient-centered, Quality of life

Abstract

Social workers in all care venues are increasingly responsible for clinical and case management services for people being treated with sophisticated medical interventions. Unfortunately, opportunities to aid in the promotion of quality of life (QOL), mental health, and informed consent are often not understood by social workers, other care providers, or patients. These missed opportunities may lead to attenuated effectiveness of medical interventions and negative impact on patients' QOL. One such technological treatment is the implantable cardioverter defibrillator (ICD), a lifesaving therapy which carries risk to patients' QOL. Moreover, patients frequently do not accurately understand the benefits, limitations, and possible risks associated with ICD therapy. A small body of literature exists addressing experimental and demographic groups at risk of QOL decrements among the ICD patient population, including those who have been shocked more than five times, older adults, female patients, and those who have experienced a life threatening cardiac event. A much more limited body of literature addresses the quality of some forms of patient educational activities and materials. No research to date has attempted to characterize potential relationships between patient information acquisition, treatment knowledge, and QOL/mental health outcomes in this patient group.

Using a cross-sectional survey of ICD patients being treated at the University of Colorado Hospital (UCH), this dissertation project uses a social-ecological approach to describe the media through which ICD patients learn about device therapy, how well they understand their treatment, QOL and mental health outcomes, and any relationships between these constructs. The project was conducted in iterative phases, including the creation of two new measures assessing patient informational media history and ICD treatment knowledge, a pilot survey of 100 randomly selected patients to assess the quality of the new measures, and a larger survey of the remaining 655 potential ICD patient participants.

A total of 205 ICD patients responded to the survey, with a mean age of 60.7 years (sd=14.53), 34.1% of whom identified as female, 10.2% of whom are African American, and 37.5% of whom live in a household with an annual income of less than $40,000. Findings from survey responses revealed both the viability of the new informational media history and ICD treatment knowledge measures, as well as broad use of a number of specific forms of media to learn about treatment. Older adult patients illustrated significantly lower treatment knowledge and use of fewer forms of informational media than their younger counterparts. Multiple regression analyses revealed significant relationships between patient history of having been shocked, health related depression, and QOL, but failed to replicate earlier findings linking these problems to demographic indicators. Each of these findings highlight opportunities for improved social work research and practice with ICD patients, including the need for improved patient education processes for older adults with these devices, and the importance of mental health status, particularly depression, to patient QOL.

Publication Statement

Copyright is held by the author. User is responsible for all copyright compliance.

Rights Holder

Christopher E. Knoepke

Provenance

Received from ProQuest

File Format

application/pdf

Language

en

File Size

159 p.

Discipline

Social Work, Health Education

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