title: Physicians' preferences and attitudes about end-of-life care in patients with an implantable cardioverter-defibrillator.
abstract: Clinical guidance is deficient regarding deactivation of implantable cardioverter-defibrillators (ICDs) in patients with terminal illnesses. We hypothesized that many physicians are apprehensive about discussing ICD deactivation with their dying patients. Thus, we conducted an anonymous survey of all the physicians in the Department of Medicine at Unity Health System in Rochester, NY. The survey collected information about the knowledge and preferences of these physicians regarding the medical, ethical, and legal issues involved in caring for patients with an ICD and terminal illness. Of the 204 surveys distributed, 87 (43%) were returned. Among the physicians who responded, 64 (74%) reported experience caring for a patient with an ICD and terminal illness. Forty physicians (46%) either thought it was illegal or were not sure if it was legal to deactivate an ICD in these circumstances. However, if reassured about the legality of discontinuing ICD therapy, 79 (91%) of these same respondents said that they would be willing to discuss voluntary ICD deactivation with their dying patients. With increased knowledge about managing the withdrawal of this potentially life-prolonging therapy, physicians are likely to become more skilled at caring for dying patients with an ICD.
authors.affiliation: Department of Community and Preventive Medicine, University of Rochester Medical Center, PO Box 644, 601 Elmwood Ave, Rochester, NY 14642, USA. saadia_sherazi@urmc.rochester.edu
authors.forename: Saadia
authors.initials: S
authors.lastname: Sherazi
authors.forename: James P
authors.initials: JP
authors.lastname: Daubert
authors.forename: Robert C
authors.initials: RC
authors.lastname: Block
authors.forename: Vinodh
authors.initials: V
authors.lastname: Jeevanantham
authors.forename: Khalid
authors.initials: K
authors.lastname: Abdel-Gadir
authors.forename: Michael R
authors.initials: MR
authors.lastname: DiSalle
authors.forename: James M
authors.initials: JM
authors.lastname: Haley
authors.forename: Abrar H
authors.initials: AH
authors.lastname: Shah
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003657:Decision Making; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010819:Physician's Role; D010817:Physician-Patient Relations; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D015996:Survival Rate / Q000639:trends; D013727:Terminal Care / Q000379:methods*; D017749:Total Quality Management; D014481:United States / Q000453:epidemiology