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Published on: February 28, 2012
Patient perceptions of implantable cardioverter-defibrillator deactivation discussions: A qualitative study
Jane MacIver1, Alana Tibbles1, Filio Billia1
1Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
Insights
Discussions about deactivating implantable cardioverter-defibrillators (ICDs) are recommended. Patients prefer discussing ICD deactivation before implantation, during health declines, and at end-of-life care planning.
Area of Science:
- Cardiology
- Medical Ethics
- Patient Care
Background:
- Current guidelines recommend physician-patient discussions regarding implantable cardioverter-defibrillator (ICD) deactivation.
- However, limited research explores patient perspectives on the optimal timing for these crucial conversations.
Purpose of the Study:
- To investigate patient awareness, preferences, and desired timing for discussions about implantable cardioverter-defibrillator deactivation.
- To understand patient viewpoints on when and how to address ICD deactivation.
Main Methods:
- A qualitative study employing grounded theory was conducted.
- Interviews were held with 25 heart failure patients implanted with an ICD at a Canadian tertiary care center.
Main Results:
- Patients desired ICD deactivation discussions at three key points: prior to implantation, during significant health deterioration while capable of communication, and at end-of-life for preference review.
- A majority (68%) of patients would consider ICD deactivation, while some remained undecided (24%) or opposed (8%).
Conclusions:
- Patient preferences underscore the importance of discussing ICD deactivation at implantation, upon clinical status changes, and within end-of-life care planning.
- Facilitating these discussions can help align patient wishes with device management, potentially reducing end-of-life shocks.
Background:
There is a class I recommendation for implantable cardioverter-defibrillator deactivation discussions to occur between physicians and heart failure patients. Few studies have reported the patient's perspective on the timing of implantable cardioverter-defibrillator deactivation discussions.
Aim:
To determine patient awareness, preferences and timing of implantable cardioverter-defibrillator deactivation discussions.
Design:
Grounded theory was used to collect and analyze interview data from 25 heart failure patients with an implantable cardioverter-defibrillator.
Setting And Participants:
Patients with an implantable cardioverter-defibrillator, from the Heart Function Clinic at University Health Network (Toronto, Canada).
Results:
The sample (n = 25) was predominately male (76%) with an average age of 62 years. Patients identified three stages where they felt implantable cardioverter-defibrillator deactivation should be discussed: (1) prior to implantation, (2) with any significant deterioration but while they were of sound mind to engage in and communicate their preferences and (3) at end of life, where patients wished further review of their previously established preferences and decisions about implantable cardioverter-defibrillator deactivation. Most patients (n = 17, 68%) said they would consider deactivation, six (24%) were undecided and two (8%) were adamant they would never turn it off.
Conclusion:
The patient preferences identified in this study support the need to include information on implantable cardioverter-defibrillator deactivation at implant, with change in clinical status and within broader discussions about end-of-life treatment preferences. Using this process to help patients determine and communicate their implantable cardioverter-defibrillator deactivation preferences may reduce the number of patients experiencing distressing implantable cardioverter-defibrillator shocks at end of life.
