Management of patients with ICDs at the end of life (EOL): a qualitative study. Academic Article uri icon

Overview

MeSH

  • Cardiology
  • Clinical Competence
  • Electrophysiology
  • Female
  • Geriatrics
  • Health Knowledge, Attitudes, Practice
  • Heart Failure
  • Humans
  • Internal Medicine
  • Male
  • Multivariate Analysis
  • Qualitative Research
  • Questionnaires
  • Self Efficacy
  • United States

MeSH Major

  • Advance Care Planning
  • Attitude of Health Personnel
  • Defibrillators, Implantable
  • Physicians
  • Terminal Care
  • Withholding Treatment

abstract

  • 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. Vignettes ascertained respondents' practices regarding implantable cardioverter defibrillator deactivation discussions. Respondents' comments were analyzed to identify themes. 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. 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.

has subject area

  • Advance Care Planning
  • Attitude of Health Personnel
  • Cardiology
  • Clinical Competence
  • Defibrillators, Implantable
  • Electrophysiology
  • Female
  • Geriatrics
  • Health Knowledge, Attitudes, Practice
  • Heart Failure
  • Humans
  • Internal Medicine
  • Male
  • Multivariate Analysis
  • Physicians
  • Qualitative Research
  • Questionnaires
  • Self Efficacy
  • Terminal Care
  • United States
  • Withholding Treatment

Research

keywords

  • Journal Article

Identity

Language

  • eng

Digital Object Identifier (DOI)

  • 10.1177/1049909108320885

PubMed ID

  • 18812618

Additional Document Info

start page

  • 440

end page

  • 446

volume

  • 25

number

  • 6