title: Patients' perspectives on end-of-life issues and implantable cardioverter defibrillators.
abstract: Increasing numbers of cardiovascular patients are receiving implantable cardioverter defibrillators (ICDs) for primary prevention of sudden cardiac death (SCD). This report examines patients' perspectives on related end-of-life issues. Using a grounded theory approach, audiotaped, semi-structured interviews were undertaken with 30 participants from two ICD referral centres in southwestern Ontario (24 who accepted an ICD and 6 who declined). Interview transcripts, verification with interviewees, researcher memos, published literature, and participant demographics were analyzed using NVivo7. Most participants were male, had comorbidities and an ejection fraction of less than 30 percent, and ranged in age from 26 to 87. Consensus was reached by three research team members on three main themes: quality versus quantity of life, preferred mode of death, and the technical realities of the ICD. The ICD was considered in relation to both quantity and quality of life. Most participants focused on the prevention of SCD, not the implications of the ICD for death by any other cause. Participants advocated for incorporating the ICD into advance care planning. Our findings have implications for the development of advance care plans and education of health professionals.
authors.affiliation: McMaster University, School of Nursing, HSC 2J20D, 1200 Main Street West, Hamilton, Ontario, Canada, L8N 3Z5. strachan@mcmaster.ca
authors.forename: Patricia H
authors.initials: PH
authors.lastname: Strachan
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Carroll
authors.forename: Sonya
authors.initials: S
authors.lastname: de Laat
authors.forename: Lisa
authors.initials: L
authors.lastname: Schwartz
authors.forename: Heather M
authors.initials: HM
authors.lastname: Arthur
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D015897:Comorbidity; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010342:Patient Acceptance of Health Care; D011322:Primary Prevention; D011788:Quality of Life