Palliative Medicine and Preparedness Planning for Patients Receiving Left Ventricular Assist Device as Destination Therapy-Challenges to Measuring Impact and Change in Institutional Culture.

Autor: Verdoorn BP; Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA., Luckhardt AJ; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA., Wordingham SE; Department of Medicine, Mayo Clinic, Phoenix, Arizona, USA., Dunlay SM; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: dunlay.shannon@mayo.edu., Swetz KM; Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Jazyk: angličtina
Zdroj: Journal of pain and symptom management [J Pain Symptom Manage] 2017 Aug; Vol. 54 (2), pp. 231-236. Date of Electronic Publication: 2017 Jan 16.
DOI: 10.1016/j.jpainsymman.2016.10.372
Abstrakt: Context: Although left ventricular assist devices as destination therapy (DT-LVAD) can improve survival, quality of life, and functional capacity in well-selected patients with advanced heart failure, there remain unique challenges to providing quality end-of-life care in this population. Palliative care involvement is universally recommended, but how to best operationalize this care and measure success is unknown.
Objectives: To characterize the process of preparedness planning (PP) for patients receiving DT-LVAD at our institution and better understand opportunities for quality improvement or procedural transferability.
Methods: Retrospective review of 107 consecutive patients undergoing DT-LVAD implantation at a single institution between 2009 and 2013. Information regarding demographics, advance care planning, and mortality was abstracted from the medical record and analyzed. Findings were compared with a historical cohort who received DT-LVAD implantation at the same institution before the development of PP (2003-2009).
Results: Mean age of patients receiving DT-LVAD was 64.3 years (SD ± 10.7). At last follow-up, 46 patients (43%) had died. Mean post-DT-LVAD survival in this group was 1.1 years (SD ± 1.2). Eighty-nine percent of patient had palliative care consultation before implantation, and 70% completed PP. Although 66% of patients completed an advance directive (AD) preimplantation, only two ADs (2.8%) specifically mentioned DT-LVAD and none addressed core elements of PP. AD completion rates improved from 47% before our policy on PP (P = 0.012).
Conclusion: A disconnect was evident between the rigor of PP discussions and the content of ADs in the medical record. We urge that future efforts focus on narrowing this gap.
(Copyright © 2017 American Academy of Hospice and Palliative Medicine. All rights reserved.)
Databáze: MEDLINE
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