Management of Patients with ICDs at the End of Life (EOL): A Qualitative Study

Purpose. Implantable cardioverter defibrillator shocks at the end of life are distressing and warrant consideration of implantable cardioverter defibrillator deactivation discussions. A nationwide survey collected physicians' comments regarding such discussions. Methods. Vignettes ascertained r...

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Bibliographic Details
Published in:American journal of hospice & palliative medicine 2009-12, Vol.25 (6), p.440-446
Main Authors: Kelley, Amy S., Mehta, Sonal S., Carrington Reid, M.
Format: Article
Language:English
Subjects:
Advance Care Planning - organization & administration
Attitude of Health Personnel
Cardiology
Clinical Competence
Defibrillators, Implantable - adverse effects
Defibrillators, Implantable - psychology
Defibrillators, Implantable - statistics & numerical data
Electrophysiology
Female
Geriatrics
Health Knowledge, Attitudes, Practice
Heart Failure - therapy
Humans
Internal Medicine
Male
Multivariate Analysis
Nursing
Physicians - psychology
Qualitative Research
Self Efficacy
Surveys and Questionnaires
Terminal Care - organization & administration
Terminal Care - psychology
United States
Withholding Treatment
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Summary:Purpose. Implantable cardioverter defibrillator shocks at the end of life are distressing and warrant consideration of implantable cardioverter defibrillator deactivation discussions. A nationwide survey collected physicians' comments regarding such discussions. Methods. Vignettes ascertained respondents' practices regarding implantable cardioverter defibrillator deactivation discussions. Respondents' comments were analyzed to identify themes. Results. About 177 respondents (32%) provided 310 comments. One third reported that initiating the discussion would depend on specific circumstances, such as do not resuscitate status (35%); 21% advocated life-prolonging therapies; 17% said the patient/family or another physician should initiate the discussion; and 9% expressed inadequate education/awareness about implantable cardioverter defibrillator functions. Geriatricians and general internists expressed inadequate knowledge most frequently (12 writers, 75% in this theme), while electrophysiologists most frequently suggested further treatments/procedures (22 writers, 58%), and another doctor (13 writers, 76%) or the patient (8 writers, 62%) should begin the discussion. Conclusions. Improving the end of life care for patients with implantable cardioverter defibrillators will require additional physician education and increased commitment by subspecialists to deactivation discussions.
ISSN:1049-9091
1938-2715
DOI:10.1177/1049909108320885