Implantable cardioverter defibrillator (ICD) functionality: Patient and family information for advanced decision-making

Loreena Hill, Sonja J McIlfatrick, Brian Taylor, L Dixon, Donna Fitzsimons

Research output: Contribution to journalArticle

Abstract

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.

LanguageEnglish
Article numbere001835
Number of pages18
JournalBMJ Supportive and Palliative Care
Early online date26 Nov 2019
DOIs
Publication statusE-pub ahead of print - 26 Nov 2019

Fingerprint

Implantable Defibrillators
Decision Making
Interviews
Equipment and Supplies
Medical Records
Shock
Communication
Delivery of Health Care

Keywords

  • Chronic conditions
  • Clinical decisions
  • Quality of life
  • Supportive care
  • clinical decisions
  • supportive care
  • quality of life
  • chronic conditions

Cite this

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abstract = "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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