Tuesday, March 9, 2010

Hospice Patients with Implantable Cardioverter Defibrillators

A study of hospice patients with implantable cardioverter defibrillator (ICD) was published in the March 2, 2010 issue of the Annals of Internal Medicine. The study shows that the devices can cause unnecessary suffering at the end-of-life. Researchers at Mount Sinai gathered survey responses from 414 hospices. While most (97%) of the responding hospices admitted patients with ICDs, nearly 60 percent of patients did not have the shocking function of the ICD deactivated. Researchers found that only 20 percent of hospices had a question on their intake forms to identify patients with ICDs, and only 10 percent reported having a policy in place to discuss deactivation with patients and their families.
“Hospices are the foremost experts at dealing with the complex communication issues surrounding end-of-life discussions with patients and their families,” study researcher Nathan Goldstein, MD, assistant professor at the Hertzberg Palliative Care Institute, Mount Sinai School of Medicine in New York City, said in a press release. “The fact that so few organizations have a policy about deactivation shows how complicated these conversations are. Having a policy in place can improve communication and provide better quality of care for patients and their families.”

Goldstein and colleagues created a sample deactivation policy based on existing programs in the hospices surveyed that has been published along with the original study. The policy outlines steps for identifying ICD devices; informed consent to deactivate the device; and processes for reprogramming ICDs — including in emergent scenarios and postmortem care. The researchers emphasized that this policy has not been pilot-tested and should be implemented only after identifying community partners who can assist with ICD reprogramming.