Decision-Making of Patients With Implantable Cardioverter-Defibrillators at End of Life: Family Members' Experiences.
Mei Ching Lee, Daniel P Sulmasy, Joseph Gallo and 7 others
PMID 27034436WHAT IT FOUND
Family members rarely knew ICD deactivation was an option; in the one reported discussion, the patient wanted the device left on.
Direct conversations gave families more confidence than written directives alone.
Key findings
01Family members reported that patients preferred shared decision-making with family or deferred decisions to a physician.
02Only one family member reported a discussion about ICD deactivation, and that patient wanted the defibrillator kept active at end of life.
03Families who had direct conversations with patients were more confident in the patients' decisions than families relying only on a written advance directive.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only six family members were interviewed. The themes cannot be assumed to apply broadly. Five of the six participants were white. Applicability to other racial and ethnic groups is limited. The study was done at one US tertiary medical center using a convenience sample. Four of the six patients had died at the time of interview. Families reported their own experiences and recollections.
Declared interests
The authors declared no potential conflicts of interest.
The easy way to misread this
Do not read these findings as proof that nurse-led discussions or advance directives improve end-of-life decisions. They come from interviews with six family members, and only one reported an ICD deactivation discussion.