Patient and cardiologist perceptions on decision making for implantable cardioverter-defibrillators: a qualitative study.
نویسندگان
چکیده
BACKGROUND Although implantable cardioverter-defibrillators (ICDs) reduce mortality in selected patients, they are also associated with potential risks. Periprocedural decision making requires understanding both benefits and risks. METHODS This qualitative study aims to understand cardiologists' and patients' perspectives about decision making surrounding ICD implantation using semi-structured, in-depth interviews. We interviewed 11 cardiologists (including four electrophysiologists) and 20 patients (14 with ICDs; six who declined ICDs). The data were analyzed through the theoretical lens of patient-centered care using the constant comparative method. RESULTS Cardiologists emphasized the benefits of ICD therapy but varied substantially in the extent to which they emphasized the various risks associated with ICD implantation with patients. Cardiologists indicated that they were influenced by the benefits of therapy as presented in published guidelines. Many patients who chose to receive an ICD indicated that they followed the advice of their physician without questioning the risks and benefits of the device. Some ICD recipients described not learning many of the risks until after device implantation or when they experienced these side effects. Patients who declined ICD implantation were concerned that the ICD was unnecessary or believed that the risks related to sudden death without an ICD did not apply to them. Only one patient considered the trade-off between dying quickly versus living longer with progressive heart failure. CONCLUSIONS In our sample, cardiologists' desire to adhere to published guidelines appears to inhibit shared decision making. The marked variability in the discussions surrounding ICD decisions highlights a need for an improved process of ICD decision making.
منابع مشابه
Perioperative Management of Patients with Implantable Cardioverter Defibrillators
The first successful implant of an automated internal defibrillation system was described in 1980. Since then the number of indications for implantable cardioverter defibrillator (ICD) therapy has grown and the number of implants has risen rapidly. As a result, growing numbers of patients with ICD’s are presenting for surgery, potentially giving rise to uncertainty about device management, espe...
متن کاملPatient perceptions of implantable cardioverter-defibrillator deactivation discussions: A qualitative study.
BACKGROUND There is a class I recommendation for implantable cardioverter-defibrillator deactivation discussions to occur between physicians and heart failure patients. Few studies have reported the patient's perspective on the timing of implantable cardioverter-defibrillator deactivation discussions. AIM To determine patient awareness, preferences and timing of implantable cardioverter-defib...
متن کاملMaking decisions about implantable cardioverter-defibrillators from implantation to end of life: an integrative review of patients' perspectives.
Implantable cardioverter-defibrillators (ICDs) are used for patients at risk of sudden cardiac death. Patients considering ICD therapy are faced with several preference-sensitive decisions. Our aim was to explore patients' ICD decision-making experiences from the decision to implant to the consideration of deactivation at end of life. We conducted an integrative review using Whittemore and Knaf...
متن کاملPerceptions and experiences of patients living with implantable cardioverter defibrillators: a systematic review and meta-synthesis
BACKGROUND Sudden cardiac deaths have become a growing major public health concern that affects the world. Despite the various etiologies, life-threatening cardiac arrhythmias attribute the main cause of sudden cardiac deaths. Therefore in certain groups of high-risk patients, the Implantable Cardioverter Defibrillator (ICD) has been recommended as either a secondary or primary prophylactic met...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Pacing and clinical electrophysiology : PACE
دوره 34 12 شماره
صفحات -
تاریخ انتشار 2011