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A large percentage of hospices don’t account for patients with defibrillator implants, which can lead to unnecessary—and uncomfortable—shocks to patients, new research shows.

More than 400 hospices responded to a recent survey from researchers at the Mount Sinai School of Medicine in New York. Of those, only 20% reported asking people whether or not they had a defibrillator implant, and only 10% reported discussing deactivating the implant with patients. The National Hospice and Palliative Care Organization recommends identifying every individual with a defibrillator who is seeking hospice care and discussing the option of deactivating the device.

Defibrillator implants are meant to be life-saving devices, but it makes no sense to continue shocking a patient if it will not fix the underlying condition, says study author Dr. Nathan Goldstein. He and his team have developed a model for informed-consent discussions about the use of defibrillator implants in end-of-life care. The research is published in the March 2 edition of the Annals of Internal Medicine.