Clinical InvestigationOutcomes, Health Policy, and Managed CareImplantable cardioverter-defibrillator deactivation at the end of life: A physician survey
Section snippets
Survey development
The survey included 5 clinical vignettes (see Appendix A) and 17 Likert-scaled items, along with items to elicit data on subjects' demographic and practice characteristics. Vignettes have been used extensively in social and biomedical research29, 30 and have been found to be particularly reliable as a measure of professional judgement.31, 32 The vignettes included in this survey were based on the clinical experience of the authors and depicted 5 patients with an ICD and a new terminal diagnosis
Results
Surveys were mailed to 4,876 physicians, 173 were returned as undeliverable and 558 (12%) physicians returned completed surveys. Respondents were predominantly white, male physicians who worked in private practices located in large northeastern cities (Table I). Most of the respondents devoted <50% of their practice to primary care and reported caring for >10 patients with ICDs, whereas almost half (48%) reported having had ≥6 discussions regarding ICD deactivation. Compared to nonrespondents,
Discussion
This study found that physicians report a substantially greater willingness to discuss advance directives and DNR with patients who have either terminal or progressive, incurable disease, as compared to ICD deactivation despite defibrillation being an integral part of resuscitation efforts. Decades of research and attention to end of life care, in addition to legislation such as the Patient Self-Determination Act, have promoted DNR and advance directives discussions as the “standard of care.”
Disclosures
Dr Kelley receives funding as a fellow in the AHRQ National Research Service Award program at the University of California Los Angeles. The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the paper and its final contents.
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