Effective communication and ethical consent in decisions related to ICDs

Alexander M. Clark*, Tiny Jaarsma, Patricia Strachan, Patricia M. Davidson, Megan Jerke, James M. Beattie, Amanda S. Duncan, Chantal F. Ski, David R. Thompson

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

19 Citations (Scopus)

Abstract

This Review examines recommendations and principles that promote good decision-making with regard to the insertion, deactivation, and potential malfunction of implantable cardioverter-defibrillators (ICDs). This guidance is important because ICDs are now used for primary and secondary prevention of arrhythmias in more than 20 diverse clinical populations, which accounts for the exponential increase in insertion rates over the past decade. Current guidelines require clinicians to provide personalized, culturally appropriate, and easy to understand information to patients on the benefits and harms of proposed treatment choices; however, obtaining valid informed consent for insertion and deactivation of ICDs is challenging. Initiating early conversations with patients and continuing this dialogue over time, implementation of localized care protocols, increased collaboration (particularly between cardiac and palliative care teams), and the provision of training for all health professionals involved in the care of these patients, can help to ensure that adequate informed consent is maintained throughout their care. In addition to providing information, health professionals should identify and address high levels of anxiety in patients and their next of kin and promote effective communication throughout decision making. In the future, use of standardized checklists or decision aids based on a clear understanding of the principles underlying key topics could support this process.

Original languageEnglish
Pages (from-to)694-705
Number of pages12
JournalNature Reviews Cardiology
Volume8
Issue number12
DOIs
Publication statusPublished - 01 Dec 2011
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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