“It’s Like Crossing a Bridge” Complexities Preventing Physicians from Discussing Deactivation of Implantable Defibrillators at the End of Life
Key result
Physicians rarely initiate discussions about ICD deactivation at the end of life due to the device's small internal nature, its primary life-saving role, lack of established patient rapport, and general concerns about withdrawing care.
Why the study?
What are the barriers preventing physicians from discussing the deactivation of implantable cardioverter defibrillators at the end of life?
Population
12 physicians from 3 states
Design
Other
Authors
Discussion
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Member takes
Implication
Barriers to end-of-life ICD deactivation discussions warrant clinician awareness; leaves open whether targeted education improves communication practices.
Structured PICO
What are the barriers preventing physicians from discussing the deactivation of implantable cardioverter defibrillators at the end of life?
P
Population
12 physicians (cardiologists, electrophysiologists, and generalists) who had previously discussed ICD deactivation with patients, interviewed to understand barriers to these conversations.
E
Exposure
Qualitative one-on-one interviews regarding past experiences and barriers to discussing deactivation of Implantable Cardioverter Defibrillators (ICDs)
O
Outcome
Barriers to physician-initiated discussions about ICD deactivation in patients with advanced illness
ICDs possess unique characteristics that make end-of-life deactivation discussions difficult for physicians, highlighting a need for targeted educational interventions.
Limitations
- Small sample size
- Geographically limited to the greater New York City area
- Inability to identify and include family physicians in the study
Cite This Study
Goldstein et al. (2007) studied Physicians managing patients with Implantable Cardioverter Defibrillators (ICDs) at the end of life (n=12). Discussions about ICD deactivation was evaluated on Barriers to physician-initiated discussions about ICD deactivation. Physicians rarely initiate discussions about ICD deactivation at the end of life due to the device's small internal nature, its primary life-saving role, lack of established patient rapport, and general concerns about withdrawing care.