Please select the eligibility criteria that correspond to the clinical trial below.
Title: An Intervention to Improve ICD Deactivation Conversations (WISDOM - Working to Improve discuSsions About DefibrillatOr Management)
Brief Summary: An Implantable Cardioverter-Defibrillator (ICD) is a device implanted in a patient's chest to monitor the heart rhythm and deliver shocks to terminate potentially lethal arrhythmias when necessary. While ICDs reduce sudden cardiac death, patients with ICDs eventually die of heart failure or other diseases. As patients near the end of life, physiologic changes (intrinsic and extrinsic to the heart) may affect the cardiac conduction system, leading to more arrhythmias and increasing the frequency of shocks. Because ICD shocks can cause pain and anxiety and may not prolong a life of acceptable quality, it is appropriate to consider deactivating the shocking function of ICDs as patients' clinical status worsens and death is near. This will be a randomized controlled trial of a physician centered counseling and education intervention to improve clinician-patient communication about the management of ICDs.


Options:
A: DISEASE CHARACTERISTICS:

* Diagnosis of advanced cancer (stage IV disease) AND meets all of the following criteria:

  * Referred by participating physician
  * Must speak English
  * Receiving primary oncology care at participating centers, defined as at least 2 visits to the clinic during the past year and a future scheduled appointment
  * Receiving treatment for any malignancy
  * Has access to a telephone

PATIENT CHARACTERISTICS:

* Not specified

PRIOR CONCURRENT THERAPY:

* See Disease Characteristics
B: Inclusion Criteria:

* Mechanically ventilated ≥ 7 days
* Mechanically ventilated without \> 96 hour interruption
* Age ≥ 21 years
* ICU MD does not expect patient will die within 72 hours
* ICU MD does not expect patient will be liberated from the ventilator within 72 hours.

Exclusion Criteria:

* Previous admission to study ICU this hospitalization Mechanically ventilated at outside hospital for \> 7 days before transfer
* Chronic Neuromuscular (NM) Disease
* Trauma
* Burn
* Previous palliative care consultation in this hospitalization
* No family or other surrogate decision-maker
* Family not available
* Surrogate lacks English proficiency
* Physician refused permission for research staff to approach the family
C: Inclusion Criteria:

* Resident in long time care ward in Bergen, Bærum, Sarpsborg, Kvam, Fjell, Sund, Askøy and Øygarden

Exclusion Criteria:

* Dying patients with reduced consciousness at baseline
* Active Schizophrenia
D: Inclusion Criteria:

Clinicians:

* At all sites, a core group of approximately 10 heart failure clinicians (physicians, nurses) care exclusively for patients with advanced heart failure in both inpatient and outpatient settings; all of these clinicians are eligible..

Patients:

* Patient does not currently have a ventricular assist device
* Age \> 18
* Fluent in English
* Consistent and reliable access to a phone

For Inpatient:

* Has had at least 1 other heart failure in the last year, OR
* Meets all three of the following criteria at time of admission:

  1. BUN \> 43
  2. SBP ≤ 115
  3. CR \> 2.75 OR
* Was on inotropes OR intravenous diuretics OR intravenous heart failure treatments in emergency department OR in outpatient setting prior to the current hospital admission

For Outpatient

* Has had 2 or more heart failure related admissions in the last year OR
* Has class IV heart failure in the outpatient setting OR
* Has Class III heart failure in outpatient setting AND 1 heart failure related admission in the last year OR
* Has Class III heart failure in outpatient setting AND 2 of the following 4 conditions:

  1. Age ≥ 70
  2. BUN ≥ 43
  3. Cr ≥ 2.75
  4. SBP≤115 OR
* Is on inotropes (e.g., dobutamine, milrinone) OR intravenous diuretics OR intravenous heart failure treatments in emergency department OR in outpatient setting

Caregivers:

* Age \> 18
* Fluent in English
* Consistent and reliable access to a phone

Exclusion Criteria for patients:

* Not having an ICD

Answer: D