Key result
A scoping review of 63 texts on ICD deactivation at end-of-life identified key gaps regarding who should initiate discussions, how to conduct them, timing, and family perspectives.
Why the study?
Communication about deactivation of implantable cardioverter-defibrillator therapy at end-of-life is a recognised clinical issue, prompting a scoping review to map the literature with a focus on interventional studies.
Systematic Review (n=63)
There are significant gaps in the literature regarding the practical aspects of communicating ICD deactivation at the end of life, highlighting a need for clinician education and protocol changes.
Gaps in responsibility, timing, and family perspectives for ICD deactivation discussions warrant caution in practice; leaves open optimal strategies pending interventional trials.
OBJECTIVES: Communication about deactivation of implantable cardioverter-defibrillator (ICD) therapy at end-of-life (EoL) is a recognised issue within clinical practice. The aim of this scoping review was to explore and map the current literature in this field, with a focus on papers which implemented interventional studies. METHODS: Systematic searches of six major databases were conducted. Citations were included by four researchers according to selection criteria. Key demographic data and prespecified themes in relation to communication of ICD deactivation at EoL were extracted. RESULTS: The search found 6197 texts of which 63 were included: 39 quantitative, 14 qualitative and 10 mixed-methods. Surveys were predominantly used to gather data (n = 34), followed by interviews (n = 18) and retrospective reviews of patient records (n = 18). CONCLUSIONS: Several key gaps in the literature warrant further research. These include who is responsible for initiating ICD deactivation discussions, how clinicians should initiate and conduct these discussions, when ICD deactivations should be occurring, and family perspectives. Adequately explored themes include patient and clinician knowledge and attitudes regarding ICD deactivation at EoL. PRACTICAL IMPLICATIONS: Facilities treating patients with ICDs at EoL should consider ongoing quality improvement projects aimed at clinician education and protocol changes to improve communication surrounding EoL ICD deactivation.
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Callaghan et al. (2022) conducted a systematic review in Implantable cardioverter-defibrillator (ICD) therapy at end-of-life (n=63). Communication regarding ICD deactivation was evaluated on Themes in relation to communication of ICD deactivation at end-of-life. A scoping review of 63 texts on ICD deactivation at end-of-life identified key gaps regarding who should initiate discussions, how to conduct them, timing, and family perspectives.
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