Patient Preference in the Decision to Place Implantable Cardioverter-Defibrillators

Caverly, Tanner J.; Al‐Khatib, Sana M.; Kutner, Jean S.; Masoudi, Frederick A.; Matlock, Daniel D.

doi:10.1001/archinternmed.2012.2177

Cited by 26 publications

(19 citation statements)

References 8 publications

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“…Prior studies have suggested that clinicians weigh guidelines and mortality data to be more important than patients’ preferences in their recommendations for ICDs. 6 In a related study, physicians also used very strong language in their recommendations for ICDs, 5 and as a consequence, patients often did not feel fully informed. 7 Our findings expand upon this prior work by using contemporary theories from psychology to provide depth and specificity regarding mechanisms behind how varying communication strategies can influence decisions.…”

Section: Discussionmentioning

confidence: 99%

“…5 A survey of cardiologists suggested that mortality data and guidelines were more important than patient preferences or patient knowledge in their recommendations for ICDs. 6 A review of studies of patients’ perceptions suggested that physicians generally employed a paternalistic approach to the decision to receive an ICD and patients often felt uninformed. 7 …”

Section: Introductionmentioning

confidence: 99%

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Evidence of Cognitive Bias in Decision Making Around Implantable-Cardioverter Defibrillators: A Qualitative Framework Analysis

Matlock

Jones

Nowels

et al. 2017

Journal of Cardiac Failure

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Background Prior studies have demonstrated that patients with primary prevention implantable cardioverter-defibrillators (ICD) often misunderstand the ICD. Advances in behavioral economics demonstrate that some misunderstandings may be due to cognitive biases. We aimed to explore the influence of cognitive bias on ICD decision making. Methods and Results We used a qualitative framework analysis including 9 cognitive biases: affect heuristic, affective forecasting, anchoring, availability, default effects, halo effects, optimism bias, framing effects, and state dependence. We interviewed 48 patients from 4 settings in Denver: The majority were male (n=32). Median age was 61. We found frequent evidence for framing, default, and halo effects; some evidence of optimism bias, affect heuristic, state dependence, anchoring and availability bias; and little or no evidence of affective forecasting. Framing effects were apparent in overestimation of benefits and downplaying or omitting potential harms. Conclusions We found evidence of cognitive bias in decision making for ICD implantation. The majority of these biases appeared to encourage ICD treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evidence of Cognitive Bias in Decision Making Around Implantable-Cardioverter Defibrillators: A Qualitative Framework Analysis

Matlock

Jones

Nowels

et al. 2017

Journal of Cardiac Failure

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“…Another study identified that physicians were frightened to tell the patients too many of the risks because they didn't want them to make a “bad decision.” 69 A survey of over 1200 members of the American College of Cardiology noted that physicians rated guidelines and mortality data much higher than patient preferences or patient knowledge in their recommendations for ICDs. 71 …”

Section: Current Knowledgementioning

confidence: 99%

Implantable Cardioverter–Defibrillator Use in Older Adults

Kramer

Matlock

Buxton

et al. 2015

Circ: Cardiovascular Quality and Outcomes

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“…In the case of ICDs, current evidence suggests that patients are not as informed as they should be with evidence suggesting disempowered patients 36 and paternalistic physicians who think their patients’ preferences do not matter. 37 Anticipated adverse events and the possibility of rare unexpected events should be reviewed. Information including statistics is difficult for patients to assimilate; use of natural frequencies instead of percentages such as “If we put this in 100 patients like you, we would expect….” may facilitate understanding.…”

Section: Fate Of Cardiac Devices Intended To Prolong Lifementioning

confidence: 99%

Life-Saving Devices Reach the End of Life with Heart Failure

Matlock

Stevenson

2012

Progress in Cardiovascular Diseases

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The new millennium has seen a dramatic increase in use of potentially life-prolonging devices such as implantable cardioverter-defibrillators (ICDs) and ventricular assist devices (VADs) among patients with advanced heart failure. Most patients who receive these devices will have them in place when they die. Clinicians who care for these patients must commit through the entire course of therapy, including the end-of-life. Discussions about device deactivation should be the standard of care and this discussion should take place prior to implantation, during annual heart failure reviews, after major milestones, and when the end-of-life appears to be approaching. Turning off ICDs and turning off VADs in response to patient or proxy requests are legally the same although they may be perceived differently, as disconnection of the VAD is more likely to cause immediate death. This article discusses the evidence around device deactivation at the end-of-life and offers suggestions for improvement.

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Patient Preference in the Decision to Place Implantable Cardioverter-Defibrillators

Abstract: fect, guidelines should consistently emphasize the importance of patient preferences in all clinical decisions.

Cited by 26 publications

References 8 publications

Evidence of Cognitive Bias in Decision Making Around Implantable-Cardioverter Defibrillators: A Qualitative Framework Analysis

Evidence of Cognitive Bias in Decision Making Around Implantable-Cardioverter Defibrillators: A Qualitative Framework Analysis

Implantable Cardioverter–Defibrillator Use in Older Adults

Life-Saving Devices Reach the End of Life with Heart Failure

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