"It's like crossing a bridge" complexities preventing physicians from discussing deactivation of implantable defibrillators at the end of life

Nathan E. Goldstein*, Davendra Mehta, Ezra Teitelbaum, Elizabeth H. Bradley, R. Sean Morrison

*Corresponding author for this work

Research output: Contribution to journalArticle

98 Scopus citations

Abstract

OBJECTIVE: To understand potential barriers to physician-initiated discussions about Implantable Cardioverter Defibrillator (ICD) deactivation in patients with advanced illness. DESIGN: Qualitative one-on-one interviews. PARTICIPANTS: Four electrophysiologists, 4 cardiologists, and 4 generalists (internists and geriatricians) from 3 states. APPROACH: Clinicians were interviewed using open-ended questions to elicit their past experiences with discussing deactivating ICDs and to determine what barriers might impede these discussions. Transcripts of these interviews were analyzed using the qualitative method of constant comparison. RESULTS: Although many physicians believed that conversations about deactivating ICDs should be included in advance care planning discussions, they acknowledged that they rarely did this. Physicians indicated that there was something intrinsic to the nature of these devices that makes it inherently difficult to think of them in the same context as other management decisions at the end of a patient's life. Other explanations physicians gave as to why they did not engage in conversations included: the small internal nature of these devices and hence absence of a physical reminder to discuss the ICD, the absence of an established relationship with the patient, and their own general concerns relating to withdrawing care. CONCLUSION: Whereas some of the barriers to discussing ICD deactivation are common to all forms of advance care planning, ICDs have unique characteristics that make these conversations more difficult. Future educational interventions will need to be designed to teach physicians how to improve communication with patients about the management of ICDs at the end of life.

Original languageEnglish (US)
Pages (from-to)2-6
Number of pages5
JournalJournal of general internal medicine
Volume23
Issue number1 SUPPL.
DOIs
StatePublished - Jan 1 2008

Keywords

  • Advanced technology
  • Communication
  • Implantable cardioverter defibrillator
  • Palliative care
  • Patient-physician relationship

ASJC Scopus subject areas

  • Internal Medicine

Fingerprint Dive into the research topics of '"It's like crossing a bridge" complexities preventing physicians from discussing deactivation of implantable defibrillators at the end of life'. Together they form a unique fingerprint.

Cite this