title: Patient-assisted computerized education for recipients of implantable cardioverter defibrillators: a randomized controlled trial of the PACER program.
abstract: 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.
  
  
  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.
  
  
  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.
authors.affiliation: American Psychiatric Institute for Research and Education, Division of Research, American Psychiatric Association, Arlington, Virginia 22209, USA. eakuhl@gmail.com
authors.forename: Emily A
authors.initials: EA
authors.lastname: Kuhl
authors.forename: Samuel F
authors.initials: SF
authors.lastname: Sears
authors.forename: Lauren D
authors.initials: LD
authors.lastname: Vazquez
authors.forename: Jamie B
authors.initials: JB
authors.lastname: Conti
mesh_terms: D000223:Adaptation, Psychological; D000704:Analysis of Variance; D001007:Anxiety / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D001292:Attitude to Computers; D001294:Attitude to Health; D003194:Computer-Assisted Instruction / Q000379:methods*; D017147:Defibrillators, Implantable / Q000009:adverse effects / Q000523:psychology*; D004521:Educational Measurement; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015402:Nursing Education Research; D010353:Patient Education as Topic / Q000379:methods*; D010865:Pilot Projects; D011788:Quality of Life / Q000523:psychology; D012044:Regression Analysis; D015144:Southeastern United States; D011795:Surveys and Questionnaires