"Why Would I Choose Death?": A Qualitative Study of Patient Understanding of the Role and Limitations of Cardiac Devices.
Rachel A Hadler, Nathan E Goldstein, David B Bekelman and 5 others
PMID 30789490WHAT IT FOUND
Patients with cardiac devices often misunderstand the device's role, viewing it as a life-saving technology that guarantees future treatments.
This belief, reinforced by limited discussion of prognosis, makes them resistant to advance care planning.
Key findings
01Most patients with cardiac devices had not discussed future deactivation with their providers.
02Patients frequently overestimated the device's function, believing it could treat the underlying heart failure rather than just arrhythmias.
03Expectations of ongoing technological advances, such as new pumps or transplants, conflicted with engagement in palliative care planning.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Single-site study at a US academic tertiary care hospital. Sample was predominantly male and white, limiting generalizability. Small number of patients with advanced therapies like left ventricular assist devices.
Declared interests
The authors have no conflicts of interest to declare. The study was supported by the National Institutes of Health.
The easy way to misread this
Do not assume that patients who have been defibrillated and survived understand the device's limitations. Their positive experience may reinforce a belief that the device saves lives from heart failure progression, making them resistant to discussions about deactivation or palliative care.