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Cited by 118Palliative Care and End-of-Life IssuesCardiac pacing and defibrillation studiesPalliative and Oncologic Care

“It’s Like Crossing a Bridge” Complexities Preventing Physicians from Discussing Deactivation of Implantable Defibrillators at the End of Life

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Goldstein, Nathan E., Mehta, Davendra, Teitelbaum, Ezra, Bradley, Elizabeth H., Morrison, R. Sean·2008·Journal of General Internal Medicine
DOI 10.1007/s11606-007-0237-xPMC PMC2150631
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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.

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  • Few patients or families discuss the option of device deactivation with their physicians before the days preceding death, even among patients with do-not-resuscitate orders or during terminal situations.

    “yet few patients or families discuss the option of device deactivation with their physicians before the days preceding death, even among patients with do-notresuscitate orders, or during terminal situations.”

    From Managing with pacemakers and implantable cardioverter defibrillators (2013) · cites this paper as [45]

    The Introduction says clinicians and patients rarely discuss ICD deactivation, and the Discussion says such conversations rarely occur during advance care planning for serious illness. Neither passage establishes that discussions wait until the days preceding death or that they are rare specifically among patients with do-not-resuscitate orders or in terminal situations; the Introduction’s reference to the last days of life concerns ICD shocks, not discussions. (LLM, conf=0.87)

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  • Many patients do not know that device deactivation is an available option.

    “Many do not know that device deactivation is an available option.33,44,45”

    From Managing with pacemakers and implantable cardioverter defibrillators (2013) · cites this paper as [45]

    The Methods describe interviews with physicians, and the Results report that deactivation discussions rarely occurred. The Discussion mentions patients’ reluctance to discuss deactivation, but none of these passages establishes that many patients do not know deactivation is an option (searched for patient awareness and knowledge of that option). (LLM, conf=0.75)

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Authors
Goldstein, N. E., Mehta, D., Teitelbaum, E., Bradley, E. H., & Morrison, R. S.
Affiliations
  • Mount Sinai Hospital (US)
  • Icahn School of Medicine at Mount Sinai (US)
  • Yale University (US)
  • James J. Peters VA Medical Center (US)
Corresponding author
Goldstein, Nathan E.
ORCID
Venue
Journal of General Internal Medicine
Publisher
Springer Science and Business Media LLC
Published
2007-12-19
Volume
23
Issue
S1
Pages
2-6
ISSN
  • 0884-8734 (ISSN-L)
  • 1525-1497
DOI
10.1007/s11606-007-0237-x
PMC
PMC2150631
OpenAlex
W2061735047
Cited by
118
References
47
Citations by year
2026: 2 · 2025: 1 · 2024: 2 · 2023: 2 · 2022: 2 · 2021: 4 · 2020: 6 · 2019: 10 · 2018: 3 · 2017: 8 · 2016: 3 · 2015: 12 · 2014: 5 · 2013: 9 · 2012: 17
FWCI
7.24
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of General Internal Medicine (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • DigitalGeorgetown (Georgetown University Library) (submittedVersion)
Funders
  • American Federation for Aging Research
  • Patrick and Catherine Weldon Donaghue Medical Research Foundation
  • National Palliative Care Research Center
  • National Institute on Aging (K23AG025933, K24AG022345, 1K24 AG 22345‐01)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
Keywords
end-of-life care, advance care planning, physician-patient communication, barriers to discussion, withdrawal of life-sustaining treatment, physician attitudes, advanced disease, physician training
MeSH terms
Adult, Decision Making, Female, Humans, Interviews as Topic, Male, Middle Aged, Physician-Patient Relations, Physician's Role, Surveys and Questionnaires, Terminal Care, United States, Defibrillators, Implantable, Total Quality Management, Withholding Treatment, Advance Care Planning

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