Missed opportunities! End of life decision making and discussions in implantable cardioverter defibrillator recipients Academic Article uri icon


  • BACKGROUND:Recent guidelines highlight the need for clinician-patient discussions regarding end-of-life (EOL) choices prior to implantable cardioverter defibrillator (ICD) implantation. Health literacy could affect the quality and quantity of such discussions. OBJECTIVE:Our objective was to determine the association of health literacy with experiences, attitudes, and knowledge of the ICD at EOL. METHODS:In this cross-sectional study, we used validated instruments to measure health literacy and patient experiences, attitudes, and knowledge of the ICD at EOL. RESULTS:Of the 240 ICD recipients, 76% of participants reported never having discussed the implications of a future withdrawal of defibrillation therapy with their healthcare provider. Increased odds of choosing to maintain defibrillation therapy were associated with female gender and lower ICD knowledge. CONCLUSIONS:From patients' perspectives, EOL discussions with providers were minimal. Most patients hold misperceptions about ICD function that could interfere with optimal EOL care, particularly for those with inadequate health literacy.


  • Miller, Jennifer L
  • Chung, Misook L
  • Etaee, Farshid
  • Hammash, Muna
  • Thylén, Ingela
  • Biddle, Martha J
  • Elayi, Samy C
  • Czarapata, Mary M
  • McEvedy, Samantha
  • Cameron, Jan
  • Haedtke, Christine A
  • Ski, Chantal F
  • Thompson, David R
  • Moser, Debra K

publication date

  • 2019

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