title: [Treating ICD patients at the end of their lives: attitudes, knowledge, and behavior of doctors and patients. A critical literature analysis].
abstract: BACKGROUND
  The implantable cardioverter-defibrillator (ICD) is highly effective in the therapy of malign heart rhythm abnormalities. However, the ethical dilemma of harming a dying patient has received little attention. We studied the current state of knowledge and behavior of physicians and the subjective needs of ICD patients with respect to end-of-life issues.
  
  
  METHODS
  A literature search of articles published between 8/2010 and 3/2011 in PubMed resulted in the identification of 32 reports, of which 25 met selection criteria.
  
  
  RESULTS
  Practically no clinical institution (96% in Europe) offers routine counseling of ICD patients on end-of-life issues. In only about 25% of cases do doctors initiate a discussion on this issue with the ICD patient, of which the majority takes place during the final hours of the patient's life. Knowledge of legal aspects of ICD deactivation is insufficient in about 50% of physicians. Many physicians underestimate the impact of ICD shocks and often have unrealistic expectations about the patient's knowledge on technical aspects of the ICD device. The majority of patients are reluctant to address this topic and prefer to rely on the decision of their attending physician.
  
  
  CONCLUSIONS
  Despite insufficient empirical data, findings point to a low willingness of ICD patients to confront the end-of-life issue and prefer decisions to be made by their physician. Substantial knowledge gaps of physicians may cause barriers in considering the option of deactivating the ICD.
authors.affiliation: Institut für Epidemiologie (EPI-II), Helmholtz Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt, Ingolstädter Landstr. 1, 85764, Neuherberg, Deutschland. ladwig@helmholtz-muenchen.de
authors.forename: K-H
authors.initials: KH
authors.lastname: Ladwig
authors.forename: N F
authors.initials: NF
authors.lastname: Ischinger
authors.forename: J
authors.initials: J
authors.lastname: Ronel
authors.forename: C
authors.initials: C
authors.lastname: Kolb
mesh_terms: D001291:Attitude of Health Personnel; D003142:Communication; D003144:Communication Barriers; D003376:Counseling / Q000941:ethics / Q000331:legislation & jurisprudence; D003625:Data Collection; D017147:Defibrillators, Implantable / Q000941:ethics* / Q000523:psychology*; D020878:Device Removal / Q000941:ethics / Q000331:legislation & jurisprudence / Q000523:psychology; D004992:Ethics, Medical; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010353:Patient Education as Topic / Q000941:ethics / Q000331:legislation & jurisprudence; D010358:Patient Participation / Q000331:legislation & jurisprudence / Q000523:psychology; D010817:Physician-Patient Relations / Q000941:ethics*; D013727:Terminal Care / Q000941:ethics* / Q000331:legislation & jurisprudence / Q000379:methods* / Q000523:psychology*