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ICD Recipients’ Understanding of Ethical Issues, ICD Function, and Practical Consequences of Withdrawing the ICD in the End‐of‐Life
Author(s) -
STRÖMBERG ANNA,
FLUUR CHRISTINA,
MILLER JENNIFER,
CHUNG MISOOK L.,
MOSER DEBRA K.,
THYLÉN INGELA
Publication year - 2014
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/pace.12353
Subject(s) - medicine , implantable cardioverter defibrillator
Background The current international expert consensus statements recommend that clinicians should discuss elective implantable cardioverter defibrillator (ICD) deactivation before implantation of the device, and then consistently during the illness trajectory. However, no previous studies have investigated predictors of ICD patients’ knowledge about end‐of‐life issues or whether knowledge influences patients’ attitudes about deactivation. Methods This nationwide survey study (n = 3,067) had a cross‐sectional correlational design of self‐reported data. Participants were recruited from the Swedish ICD and Pacemaker Registry and asked to complete a questionnaire about knowledge in relation to the ICD and end‐of‐life. Results Only 79 respondents (3%) scored correctly on all 11 questions. The mean sample score was 6.6 ± 2.7 out of a maximum score of 11. A total of 835 participants (29%) had an insufficient knowledge when using the 25th percentile as a cutoff. Younger ICD recipients, those cohabiting, male participants, and those who had received shocks, had a generator replacement, or who had discussed illness trajectory with their physician were more likely to have sufficient knowledge on the end‐of‐life issues. Insufficient knowledge was associated with indecisiveness to make decisions about ICD deactivation in the end‐of‐life situations, and with favorable attitudes about replacing the ICD even if seriously ill or have reached an advanced age, and keeping the shock therapy of the ICD even in a terminal phase of life when dying from cancer or other serious chronic illnesses. Conclusion Insufficient knowledge is common among ICD recipients and is associated with attitudes and decisions that may result in a stressful and potentially painful end‐of‐life situation.