Patient perceptions of implantable cardioverter-defibrillator deactivation discussions: A qualitative study.
BACKGROUND
There is a class I recommendation for implantable cardioverter-defibrillator deactivation discussions to occur between physicians and heart failure patients. Few studies have reported the patient's perspective on the timing of implantable cardioverter-defibrillator deactivation discussions.


OBJECTIVE
To determine patient awareness, preferences and timing of implantable cardioverter-defibrillator deactivation discussions.


METHODS
Grounded theory was used to collect and analyze interview data from 25 heart failure patients with an implantable cardioverter-defibrillator.


METHODS
Patients with an implantable cardioverter-defibrillator, from the Heart Function Clinic at University Health Network (Toronto, Canada).


RESULTS
The sample (n = 25) was predominately male (76%) with an average age of 62 years. Patients identified three stages where they felt implantable cardioverter-defibrillator deactivation should be discussed: (1) prior to implantation, (2) with any significant deterioration but while they were of sound mind to engage in and communicate their preferences and (3) at end of life, where patients wished further review of their previously established preferences and decisions about implantable cardioverter-defibrillator deactivation. Most patients (n = 17, 68%) said they would consider deactivation, six (24%) were undecided and two (8%) were adamant they would never turn it off.


CONCLUSIONS
The patient preferences identified in this study support the need to include information on implantable cardioverter-defibrillator deactivation at implant, with change in clinical status and within broader discussions about end-of-life treatment preferences. Using this process to help patients determine and communicate their implantable cardioverter-defibrillator deactivation preferences may reduce the number of patients experiencing distressing implantable cardioverter-defibrillator shocks at end of life.
Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
Jane
J
MacIver
Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
Alana
A
Tibbles
Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
Filio
F
Billia
Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
Heather
H
Ross
Implantable cardioverter-defibrillator; advance care planning; heart failure; palliative care