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Patient and Cardiologist Perceptions on Decision Making for Implantable Cardioverter‐Defibrillators: A Qualitative Study
Author(s) -
MATLOCK DAN D.,
NOWELS CAROLYN T.,
MASOUDI FREDERICK A.,
SAUER WILLIAM H.,
BEKELMAN DAVID B.,
MAIN DEBORAH S.,
KUTNER JEAN S.
Publication year - 2011
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2011.03237.x
Subject(s) - medicine , implantable cardioverter defibrillator , sudden cardiac death , intensive care medicine , medical emergency , emergency medicine , cardiology
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. (PACE 2011; 34:1634–1644)