Patient Perceptions, Physician Communication, and the Implantable Cardioverter-Defibrillator The Implantable Cardioverter-Defibrillator

Hauptman PJ, Chibnall JT, Guild C, et al. — Mon, 08 Apr 2013 00:00:00 GMT

Importance

Implantable cardioverter-defibrillators (ICDs) have changed the way in which patients with chronic ventricular dysfunction are evaluated and treated.

Objective

To examine patient-physician communication at the time the decision is made to implant an ICD.

Design, Setting, and Participants

Forty-one patients with ICDs and 11 cardiologists were recruited by a national marketing research company for a study comprising patient focus groups and standardized patient interviews in 3 different metropolitan areas.

Interventions

Eight patient focus groups and (separately) 22 standardized patient interviews with cardiologists.

Main Outcome Measures

Patient focus group findings and the results of standardized patient interviews (each cardiologist interviewed 2 patients).

Results

The mean (SD) patient age was 61.4 (14.7) years; 21 were female. Thirty-three patients could not recall a discussion about periprocedural or long-term complications. On a scale of 1 to 10, the mean (SD) rating of the degree to which patients felt informed before the implant procedure was 5.7 (3.2) (1 indicates “not at all informed,” and 10 indicates “I had all the information I needed or wanted”). The mean (SD) estimated number of patients out of 100 who would be saved by the ICD was 87.9 (20.1). A negative perception on body image and lifestyle was prevalent. Across 22 standardized patient interviews, cardiologists frequently (in >17 of 22 of interviews) did not address or minimized or denied quality-of-life issues and long-term consequences of ICD placement, including the risk for depression, anxiety, and inappropriate delivery of shock or device advisory. In 15 of 22 of the standardized patient interviews, cardiologists used unexplained medical terms or jargon.

Conclusions and Relevance

Patient-physician communication about ICDs is characterized by unclear representation and omission of information to patients, with notable lack of attention to psychological and long-term risks. Training of cardiologists on information exchange with patients may promote informed decision making and preempt threats to patient quality of life.

Less Patient-Centered Care An Unintended Consequence of Guidelines? Comment on “Patient Perceptions, Physician Communication, and the Implantable Cardioverter-Defibrillator” Less Patient-Centered Care

Lin GA, Matlock DD. — Mon, 08 Apr 2013 00:00:00 GMT

Sudden cardiac death is a leading cause of death in the United States and worldwide. The first successful insertion of an implantable cardioverter-defibrillator (ICD) in the 1980s heralded a new era of treatment for sudden cardiac death. Although ICDs were initially implanted to prevent the death of patients who had survived a potentially lethal arrhythmia, randomized controlled trials have also demonstrated the efficacy of ICDs for patients at high risk of having a sudden cardiac death. Consequently, ICDs have become a guideline-recommended mainstay of treatment for the primary and secondary prevention of sudden cardiac death.

JAMA Internal Medicine: Pacemakers/Defibrillators Topic Collection

Patient Perceptions, Physician Communication, and the Implantable Cardioverter-Defibrillator The Implantable Cardioverter-Defibrillator

Less Patient-Centered Care An Unintended Consequence of Guidelines? Comment on “Patient Perceptions, Physician Communication, and the Implantable Cardioverter-Defibrillator” Less Patient-Centered Care