Purpose: Despite their mortality benefit, Implantable Cardioverter Defibrillators (ICDs) have potential risks. This study aims to understand cardiologists' perspectives about the factors important in their decision to recommend ICD implantation for the primary prevention of sudden cardiac death.
Method: This qualitative study utilized open-ended in-depth interviews with 12 cardiologists (including 4 electrophysiologists) with experience in counseling patients surrounding ICD decision making. The interviews were recorded and transcribed and the data were analyzed through the theoretical lens of patient-centered care using the constant comparative method.
Results: Study cardiologists reported that the ICD mortality benefit should be conveyed to all patients; they assume that patients want this mortality benefit (table). Cardiologists also reported that the following ICD risks should be mentioned at the time of implantation: inappropriate shocks, cosmetic concerns, procedural complications, and the need for frequent follow-up. Cardiologists had varied opinions regarding how to communicate risks and benefits and whether the following risks should be discussed: device malfunctions, psychological risks, quality-of-life, and deactivation. Some cardiologists reported a fear that discussing risks would cause the patient to decline the ICD and they acknowledged that they do not discuss all the risks (table). Cardiologists reported that ICD decision making is different than medication decision making and that a decision aid would be helpful to patients.
Conclusions: From the theoretical lens of patient-centered care, cardiologists generally take a beneficent and paternalistic approach to ICD decision making. There was little consistency among cardiologists in terms of which risks to communicate and how to communicate these risks. Interventions that improve the risk and benefit communication and patient-centeredness of care while being sensitive to cardiologists' need to do what they consider is right for the patient are needed to improve the quality of ICD decision making.
