title: Patient and cardiologist perceptions on decision making for implantable cardioverter-defibrillators: a qualitative study.
abstract: BACKGROUND
  Although implantable cardioverter-defibrillators (ICDs) reduce mortality in selected patients, they are also associated with potential risks. Periprocedural decision making requires understanding both benefits and risks.
  
  
  METHODS
  This qualitative study aims to understand cardiologists' and patients' perspectives about decision making surrounding ICD implantation using semi-structured, in-depth interviews. We interviewed 11 cardiologists (including four electrophysiologists) and 20 patients (14 with ICDs; six who declined ICDs). The data were analyzed through the theoretical lens of patient-centered care using the constant comparative method.
  
  
  RESULTS
  Cardiologists emphasized the benefits of ICD therapy but varied substantially in the extent to which they emphasized the various risks associated with ICD implantation with patients. Cardiologists indicated that they were influenced by the benefits of therapy as presented in published guidelines. Many patients who chose to receive an ICD indicated that they followed the advice of their physician without questioning the risks and benefits of the device. Some ICD recipients described not learning many of the risks until after device implantation or when they experienced these side effects. Patients who declined ICD implantation were concerned that the ICD was unnecessary or believed that the risks related to sudden death without an ICD did not apply to them. Only one patient considered the trade-off between dying quickly versus living longer with progressive heart failure.
  
  
  CONCLUSIONS
  In our sample, cardiologists' desire to adhere to published guidelines appears to inhibit shared decision making. The marked variability in the discussions surrounding ICD decisions highlights a need for an improved process of ICD decision making.
authors.affiliation: Department of Medicine, School of Medicine, University of Colorado, Aurora, Colorado 80045, USA. daniel.matlock@ucdenver.edu
authors.forename: Dan D
authors.initials: DD
authors.lastname: Matlock
authors.forename: Carolyn T
authors.initials: CT
authors.lastname: Nowels
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.forename: William H
authors.initials: WH
authors.lastname: Sauer
authors.forename: David B
authors.initials: DB
authors.lastname: Bekelman
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Main
authors.forename: Jean S
authors.initials: JS
authors.lastname: Kutner
mesh_terms: D000328:Adult; D000368:Aged; D002309:Cardiology / Q000941:ethics; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D003657:Decision Making / Q000941:ethics*; D017147:Defibrillators, Implantable / Q000941:ethics / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care / Q000941:ethics; D010361:Patients / Q000523:psychology; D010817:Physician-Patient Relations / Q000941:ethics; D036301:Qualitative Research