ICD Deactivation Knowledge Lacking in End-of-Life Care

Patient, provider knowledge of implantable cardiac devices lacking, preventing timely discussion

TUESDAY, Oct. 11 (HealthDay News) -- Patients and providers require more knowledge about the functions of implantable cardioverter-defibrillators (ICDs) and end-of-life options in order to facilitate timely ICD deactivation discussions, according to a review published in the October issue of the American Journal of Nursing.

James E. Russo, R.N., A.N.P., C.C.D.S., from the Department of Veterans Affairs Medical Center in New York City, reviewed available literature from 1999 to 2010 to identify factors delaying ICD deactivation discussions, and ways of promoting these discussions for patients with ICDs. A total of 14 studies were included to examine how providers practice and manage ICD deactivation, and how providers and patients handle these discussions.

The author found that the timing of deactivation discussions were adversely affected by providers' knowledge deficits about ICD functions and their attitudes regarding deactivation in terminally ill patients. Evidence was noted that an industry representative usually performed the ICD deactivation, thereby breaking the continuity of care. Research on patients' attitudes was limited, but it appeared that patients lacked sufficient knowledge about ICD function in order to make an informed decision about deactivation. A formal institutional policy facilitated more frequent occurrence of discussions. For terminally ill patients, deactivation was more likely when discussions were held as part of an interdisciplinary approach to care.

"Both patients and providers need better knowledge of ICD functions and options at the end of life in order to foster more timely discussion of device deactivation," the authors write.

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