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Pre-Ventricular Assist Device Palliative Care Consultation: A Qualitative Analysis
Sarah Chuzi1, Sarah Hale1, Jason Arnold1
1Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Journal of Pain and Symptom Management
|October 14, 2018
Summary
Mandatory preimplantation palliative care consultations for destination therapy ventricular assist device (DT VAD) patients are not fully addressing preparedness planning or general palliative care needs. Further research is needed for effective integration.
Area of Science:
- Cardiology
- Palliative Care
- Health Services Research
Background:
- A 2013 mandate requires palliative care access for destination therapy ventricular assist device (DT VAD) patients before surgery.
- Many VAD programs now mandate preimplantation palliative care consultations.
- The quality and comprehensiveness of these consultations are not well understood.
Purpose of the Study:
- To qualitatively analyze preimplantation palliative care consultations for DT VAD patients.
- To assess the discussion of general palliative care elements and preparedness planning.
Main Methods:
- Qualitative analysis of 68 palliative care consultation notes from DT VAD patients.
- Data collected from October 2013 to March 2018 at Northwestern Memorial Hospital.
Main Results:
- General palliative care elements were infrequently discussed.
- Preparedness planning elements (device failure, quality of life, complications, comorbidities) were discussed in a low percentage of consultations (10%-54%).
- Consultations often occurred in the ICU with a median of six days to VAD implant.
Conclusions:
- One-time preimplantation palliative care consultations do not ensure completion of preparedness planning or general palliative care assessment.
- Further investigation is required to optimize palliative care integration into preimplantation VAD care.
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