Key result
Approximately 57.7% of ICD recipients were open to discussing end-of-life device deactivation, with openness associated with living arrangements, comorbidities, ICD knowledge, and prior discussions.
Why the study?
End-of-life ICD deactivation discussions are recommended but rarely occur, and little is known about patients' openness to discussing device deactivation with clinicians.
What factors are associated with patients' openness to discussing end-of-life ICD deactivation with clinicians?
Cross-Sectional (n=293)
Yes
What factors are associated with patients' openness to discussing end-of-life ICD deactivation with clinicians?
Effect estimate: OR 0.479, 0.382, 1.172, 1.332
Nearly half of ICD patients are reluctant to discuss end-of-life device deactivation, highlighting the need to address modifiable factors like ICD knowledge and prior end-of-life discussions to facilitate shared decision-making.
Supports addressing modifiable factors like knowledge to boost openness; leaves open whether interventions improve deactivation discussions.
AIMS: It is recommended that patients and clinicians discuss end-of-life deactivation of their implantable cardioverter defibrillator (ICD) prior to device implantation and throughout the illness trajectory to facilitate shared decision-making. However, such discussions rarely occur, and little is known about patients' openness to this discussion. The purpose of this study was to explore factors associated with patients' openness to discussing end-of-life ICD deactivation with clinicians. METHODS AND RESULTS: This cross-sectional study recruited 293 patients with an ICD from outpatient clinics in the USA, Australia, and South Korea. Patients were classified into an open or resistant group based on their desire to discuss device deactivation at end of life with clinicians. Multivariable logistic regression was used to explore factors related to patients' openness to this discussion.About half of the participants (57.7%) were open to discussing such issues with their clinicians. Factors related to patients' openness to discussing device deactivation at end of life were living with someone, not having severe comorbid conditions (cancer and/or chronic kidney disease), greater ICD knowledge, and more experience discussing end-of-life issues with clinicians (odds ratio: 0.479, 0.382, 1.172, 1.332, respectively). CONCLUSION: Approximately half of the ICD recipients were reluctant to discuss device deactivation at end of life with clinicians. Unmodifiable factors were their living arrangement and severe comorbidity. ICD knowledge and prior experience discussing end-of-life issues were potentially modifiable factors in the future. These factors should be addressed when assessing patients' readiness for a shared discussion about device deactivation at end of life.
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Lee et al. (2021) conducted a cross-sectional in Implantable cardioverter defibrillator (ICD) (n=293). Patient factors (living arrangement, comorbidities, ICD knowledge, prior end-of-life discussions) was evaluated on Openness to discussing end-of-life ICD deactivation with clinicians (OR 0.479, 0.382, 1.172, 1.332). Approximately 57.7% of ICD recipients were open to discussing end-of-life device deactivation, with openness associated with living arrangements, comorbidities, ICD knowledge, and prior discussions.
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