Table 2.

Drivers of ICD generator decision-making

Driver	Sub-Category	Quote
Quantitative Data	Different Uses of Data	“Of course, ‘cause 10 is higher than 3…10 percent chance of savin’ my life is better than 3 percent of a risk that it’s gonna cause an infection.”
	Enthusiasm for Numbers	“I like the data, so I would wanna know the numbers.”
Doctor’s Recommendation		“Not being a cardiologist…I’m not a man who’s gonna take a chance of losing my life because I thought I was—I had gone to med school. I realize I haven’t.”
Prior Experiences with the Device	Previous Appropriate Shocks	“…it’s already saved my life once. The good outweighs the bad, no question in my mind.”
	Never Needed Device	“If I went 12 years without needing any therapy, I might think, geez, maybe I don’t need this after all.”
	Misattribution of Clinical Stability	“I just think that I wanna get it replaced because…I haven’t had any problems since [the initial implant]. My [ejection fraction] keeps going up.”
Prior Implant Experiences	Availability Heuristic	“That would be the fourth operation with zero complications, and I think it would be sufficient data that I wouldn’t have anything to worry about for the [next] time.”
Risk Aversion		“I’d rather have it and it not havin’ to work…The doctor don’t know. He knows the signs are improving, but you still could…[need] a defibrillation.”
Therapeutic Inertia	Extension of the Initial Implant Decision	“I knew that [a generator exchange] was part of the process of having a defibrillator…I already knew that, and I agreed to get it done. Once you agree to get somethin’ done, you certainly have to agree to the maintenance—in my mind, anyway.”
	Loss Aversion/Comfort with the Device	“…I still want it in me. I don’t know. It’s not a habit. I’m attached to it mentally. It’ll be hard to lose it.”
	Default Choice	“…I wasn’t given an option or anything. It was more so, this is what’s coming up, this is what you have to do, and when do you want to schedule?”
Misconceptions	Purpose of the Device	“I be afraid if they able to take [the generator] off and remove it, what would happen? What would my heart do without it for so long? Would it put me back to square one, or would it keep on progressin’ bein’ good?”
	Need the ICD to Live	“It was either [get the generator exchange] or not live, so it was easy [to decide].”
	Nature of the Procedure	“I was just going off of what [the clinician] said, so because they never said a new device, that never registered until I got to the hospital. It was more so of, I’m thinking batteries are like you put in a remote control, like a watch or whatever, so I’m thinking replacing the battery’s not necessarily removing the device.”