Key result
Patients and family members lacked understanding of ICD functionality and deactivation, while healthcare professionals were reluctant to initiate deactivation discussions prior to the end of life.
Why the study?
As ICD implantations rise, ensuring patients and families are equipped for future end-of-life device decisions is a growing challenge.
What are the attitudes and understanding of patients, families, and professionals regarding discussions about ICD deactivation?
What are the attitudes and understanding of patients, families, and professionals regarding discussions about ICD deactivation?
Patients and families require improved communication regarding ICD functionality and a proactive approach to discussing deactivation for shared decision-making in advanced illness.
Highlights barriers to ICD deactivation discussions and knowledge gaps; leaves open need for communication interventions before practice change.
As the number of implantable cardioverter defibrillators (ICDs) implanted continues to rise, there is a growing challenge to ensure patients and family members are adequately equipped for involvement in future end-of-life decisions concerning their device. OBJECTIVE: To explore patients', family members' and professionals' attitudes and understanding towards discussing ICD deactivation. METHODS: Case study approach using qualitative interviews and framework analysis. A total of 29 qualitative interviews were undertaken, involving patients with a device, family members and healthcare professionals. Interviews were audio-recorded, transcribed verbatim and analysed using framework analysis. Data were triangulated with information obtained from the patients' medical records (n=10). RESULTS: Three main themes: (1) Professionals were reluctant to engage in conversations concerning deactivation, particularly prior to implantation, believing this was in the patient's best interest. (2) Patients and family members had limited understanding of the implanted device and its functions. It was frequently perceived as 'life-saving' with any negativity of the shock experience seen as acceptable. (3) All patients wanted the opportunity to discuss deactivation when death was imminent, but were indecisive whether family members should be involved. Similarly, some patients felt the decision to deactivate rested solely with the medical profession while others felt it should be a joint decision between patient, family and clinical team. CONCLUSIONS: Patients and family members require improved communication and information concerning their future treatment plan and functionality of an ICD. A proactive approach to discuss deactivation would enable shared clinical decision-making in the advanced stages of illness.
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Hill et al. (2019) studied Patients with an Implantable Cardioverter Defibrillator (ICD) (n=29). Implantable cardioverter defibrillator (ICD) deactivation discussions was evaluated on Perspectives and attitudes towards discussing ICD deactivation. Patients and family members lacked understanding of ICD functionality and deactivation, while healthcare professionals were reluctant to initiate deactivation discussions prior to the end of life.
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