Physicians' Preferences and Attitudes About End-of-Life Care in Patients With an Implantable Cardioverter-Defibrillator

Sherazi, Saadia; Daubert, James P.; Block, Robert C.; Jeevanantham, Vinodh; Abdelgadir, K.; DiSalle, Michael; Haley, James M.; Shah, Abrar H.

doi:10.4065/83.10.1139

Cited by 61 publications

(54 citation statements)

References 15 publications

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“…Clinical practice guidelines recommend that information regarding ICD deactivation be discussed with patients prior to implantation and with any significant change in patient status to ensure ongoing ICD use is consistent with the patient's goals of care 26, 27. However, some physicians question whether ICD deactivation is legal or ethical,28 view ICD deactivation as morally distinct from other forms of treatment withdrawal,29 or, in some cases, believe that it is equivalent to physician‐assisted suicide or euthanasia 30. The DECIDE‐HF study will provide insights about the relative importance of ICD deactivation issues as barriers to discussions about goals of care with HF patients.…”

Section: Discussionmentioning

confidence: 99%

Barriers to goals of care discussions with hospitalized patients with advanced heart failure: feasibility and performance of a novel questionnaire

et al. 2016

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AimsGood end‐of‐life communication and decision‐making are important to patients with advanced heart failure (HF) and their families, but their needs remain unmet. In this pilot study, we describe the feasibility and performance of a novel questionnaire aimed at identifying barriers and solutions to improve communication and decision‐making about goals of care for hospitalized patients with advanced HF.MethodsWe distributed questionnaires to staff cardiologists, cardiology trainees, and cardiology nurses who provide care for HF patients at a Canadian teaching hospital. The questionnaire asked about the importance of various barriers to goals of care discussions. It also asked participants to rank their willingness to engage in goals of care discussions and their views on other clinicians could engage in such discussions.ResultsOf 76 clinicians, 44 (58%) completed the questionnaire (median completion time, 17 min). Individual survey questions had few missing responses (0% to 2%) for questions about barriers to goals of care discussions. There was appreciable discrimination of the importance of different barriers (mean scores 2.2 to 6.0 on a 7‐point scale). Preliminary data suggest that clinicians perceive patient and family factors, such as difficulty accepting a poor prognosis, as the most important barriers preventing goals of care discussions.ConclusionsIn this pilot study, we have demonstrated the feasibility of a novel questionnaire to be used in a larger multi‐centre study of end‐of‐life HF care. Essential information will be obtained to inform the design and evaluation of interventions that seek to improve communication and decision‐making about goals of care with HF patients.

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Section: Discussionmentioning

confidence: 99%

Barriers to goals of care discussions with hospitalized patients with advanced heart failure: feasibility and performance of a novel questionnaire

et al. 2016

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“…There are several obstacles to achieve effective and valuable patient education. Firstly, many professionals still feel uncomfortable discussing end-of-life issues with their patients 2,3 and lack competence and skills in how to communicate this issue. 4 Secondly, professionals may feel uncertain about if and/or when patients prefer to discuss generator replacement and deactivation, which could result in a delayed end-of-life discussion.…”

Section: Introductionmentioning

confidence: 99%

Development and evaluation of the EOL-ICDQ as a measure of experiences, attitudes and knowledge in end-of-life in patients living with an implantable cardioverter defibrillator

Thylén

Wenemark

Fluur³

et al. 2013

European Journal of Cardiovascular Nursing

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“…Sherazi et al 26 conducted a cross-sectional study (n=87) assessing physicians' knowledge of medical, legal, and ethical issues involved in ICD deactivation. Forty-six percent of participants stated that ICD deactivation was illegal and 18% questioned its ethicality.…”

Section: Misperceptions Regarding the Ethical And Legal Implications mentioning

confidence: 99%

“…26,33 Because lack of experience is often cited as a mitigating factor, educational interventions should be aimed at all levels, including medical students and residents, to increase exposure and comfort level. 28 It is important to ensure that the care team, regardless of its structure, is able to adequately address ICD deactivation.…”

Section: Develop and Implement A Conversational Protocol For Icd Deacmentioning

confidence: 99%

Lost in Translation

Mitar

Alba

MacIver

et al. 2012

Circ: Heart Failure

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Physicians' Preferences and Attitudes About End-of-Life Care in Patients With an Implantable Cardioverter-Defibrillator

Cited by 61 publications

References 15 publications

Barriers to goals of care discussions with hospitalized patients with advanced heart failure: feasibility and performance of a novel questionnaire

Barriers to goals of care discussions with hospitalized patients with advanced heart failure: feasibility and performance of a novel questionnaire

Development and evaluation of the EOL-ICDQ as a measure of experiences, attitudes and knowledge in end-of-life in patients living with an implantable cardioverter defibrillator

Lost in Translation

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