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Published on: February 28, 2012
Patient and cardiologist perceptions on decision making for implantable cardioverter-defibrillators: a qualitative
Dan D Matlock1, Carolyn T Nowels, Frederick A Masoudi
1Department of Medicine, School of Medicine, University of Colorado, Aurora, Colorado 80045, USA. daniel.matlock@ucdenver.edu
Insights
Cardiologists often focus on implantable cardioverter-defibrillator (ICD) benefits, potentially overshadowing risks for patients. This impacts shared decision-making for ICD implantation, necessitating improved discussion processes.
Area of Science:
- Cardiology
- Medical Decision Making
- Patient-Centered Care
Background:
- Implantable cardioverter-defibrillators (ICDs) reduce mortality but carry risks.
- Informed periprocedural decision-making requires understanding both benefits and risks of ICDs.
Purpose of the Study:
- To explore cardiologists' and patients' perspectives on decision-making for ICD implantation.
- To understand how patient-centered care principles apply to ICD implantation decisions.
Main Methods:
- Qualitative study using semi-structured, in-depth interviews.
- Interviewed 11 cardiologists and 20 patients (ICD recipients and decliners).
- Analyzed data using the constant comparative method through a patient-centered care lens.
Main Results:
- Cardiologists varied in emphasizing ICD risks, often influenced by guidelines.
- Many patients accepted ICDs based on physician advice, sometimes unaware of risks until later.
- Patients declining ICDs perceived them as unnecessary or risks as inapplicable.
Conclusions:
- Adherence to guidelines by cardiologists may hinder shared decision-making for ICDs.
- Variability in ICD decision discussions indicates a need for improved patient-physician communication.
- Enhancing the ICD decision-making process is crucial for patient understanding and autonomy.
Background:
Although implantable cardioverter-defibrillators (ICDs) reduce mortality in selected patients, they are also associated with potential risks. Periprocedural decision making requires understanding both benefits and risks.
Methods:
This qualitative study aims to understand cardiologists' and patients' perspectives about decision making surrounding ICD implantation using semi-structured, in-depth interviews. We interviewed 11 cardiologists (including four electrophysiologists) and 20 patients (14 with ICDs; six who declined ICDs). The data were analyzed through the theoretical lens of patient-centered care using the constant comparative method.
Results:
Cardiologists emphasized the benefits of ICD therapy but varied substantially in the extent to which they emphasized the various risks associated with ICD implantation with patients. Cardiologists indicated that they were influenced by the benefits of therapy as presented in published guidelines. Many patients who chose to receive an ICD indicated that they followed the advice of their physician without questioning the risks and benefits of the device. Some ICD recipients described not learning many of the risks until after device implantation or when they experienced these side effects. Patients who declined ICD implantation were concerned that the ICD was unnecessary or believed that the risks related to sudden death without an ICD did not apply to them. Only one patient considered the trade-off between dying quickly versus living longer with progressive heart failure.
Conclusions:
In our sample, cardiologists' desire to adhere to published guidelines appears to inhibit shared decision making. The marked variability in the discussions surrounding ICD decisions highlights a need for an improved process of ICD decision making.
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