"That's like an act of suicide" patients' attitudes toward deactivation of implantable defibrillators.
OBJECTIVE
To understand potential patient barriers to discussions about implantable cardioverter defibrillator (ICD) deactivation in patients with advanced illness.


METHODS
Qualitative focus groups.


METHODS
Fifteen community-dwelling, ambulatory patients with ICDs assigned to focus groups based on duration of time since implantation and whether they had ever received a shock from their device.


METHODS
A physician and a social worker used a predetermined discussion guide to moderate the groups, and each session was audiotaped and subsequently transcribed. Transcripts were analyzed using the method of constant comparison.


RESULTS
No participant had ever discussed deactivation with their physician nor knew that deactivation was an option. Patients expressed a great deal of anxiety about receiving shocks from their device. Participants discussed why they needed the device and expressed desire for more information about the device; however, they would not engage in conversations about deactivating the ICD. One patient described deactivation "like an act of suicide" and all patients believed that the device was exclusively beneficial. Patients also expressed a desire to have their physician make the decision about deactivation.


CONCLUSIONS
None of the patients in our study knew that they might need to deactivate their ICD as their health worsens. These community-dwelling outpatients were not willing to discuss the issue of ICD deactivation and their attitudes about deactivation might impede patients from engaging in these conversations. These findings are in contrast to findings in other advance care planning research and may be related to the unique nature of the ICD.
Goldstein
Nathan E
NE
Department of Geriatrics, Mount Sinai School of Medicine, Box 1070, One Gustave Levy Place, New York, NY 10029, USA. Nathan.Goldstein@mssm.edu
Mehta
Davendra
D
Siddiqui
Saima
S
Teitelbaum
Ezra
E
Zeidman
Jessica
J
Singson
Magdelena
M
Pe
Elena
E
Bradley
Elizabeth H
EH
Morrison
R Sean
RS
D000223:Adaptation, Psychological; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D015331:Cohort Studies; D003657:Decision Making; D017147:Defibrillators, Implantable / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D018570:Risk Assessment; D012737:Sex Factors; D013315:Stress, Psychological; D013406:Suicide, Attempted; D015996:Survival Rate; D013727:Terminal Care / Q000379:methods / Q000523:psychology*; D016312:Treatment Refusal / Q000523:psychology*