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

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“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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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: Goldstein, Nathan E.
Teitelbaum, Ezra
Bradley, Elizabeth H.
Morrison, R. Sean
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: hybrid
doi.org
Licence: cc-by-nc
creativecommons.org/licenses/by-nc/2.0 (tdm)
creativecommons.org/licenses/by-nc/2.0 (vor)
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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“It’s Like Crossing a Bridge” Complexities Preventing Physicians from Discussing Deactivation of Implantable Defibrillators at the End of Life

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