Decision-making for destination therapy left ventricular assist devices: implications for caregivers.
Decision-making for destination therapy left ventricular assist devices: implications for caregivers.
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DOI：
10.1161/circoutcomes.114.001276
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发表时间：
2015-03
期刊：
影响因子：
--
通讯作者：
Matlock DD
中科院分区：
文献类型：
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作者：
McIlvennan CK;Jones J;Allen LA;Lindenfeld J;Swetz KM;Nowels C;Matlock DD
植入中心通常需要在目标治疗左心室辅助装置（DT LVAD）植入前确定专门的护理人员;然而，围绕这一困难决定的护理人员经验相对未被探索。从2012年10月到2013年7月，我们对考虑DT LVAD的患者的护理人员进行了半结构化的深入访谈。使用混合归纳和演绎方法分析数据。我们采访了17名护理人员：10名DT LVAD患者的护理人员，6名DT LVAD死亡患者的护理人员，1名拒绝DT LVAD患者的护理人员。所确定的主题，也可以被认为是辩证的紧张关系，在映射到决策背景，过程和结果的三个领域中进行了广泛的解释：1）严峻的决策背景，希望和现实之间的紧张关系; 2）具有挑战性的决策过程，希望亲人生活和希望尊重亲人的愿望之间的紧张关系;（3）下游决策结果，感恩与负担之间的张力。围绕DT LVAD的决策应包括对患者和护理人员的决策支持。这应该包括关注照顾者的负担和照顾者所经历的可预见的紧张关系。
Implanting centers often require the identification of a dedicated caregiver prior to destination therapy left ventricular assist device (DT LVAD) implantation; however, the caregiver experience surrounding this difficult decision is relatively unexplored. From October 2012 through July 2013, we conducted semi-structured, in-depth interviews with caregivers of patients considering DT LVAD. Data were analyzed using a mixed inductive and deductive approach. We interviewed 17 caregivers: 10 caregivers of patients living with DT LVAD, 6 caregivers of patients who had died with DT LVAD, and 1 caregiver of a patient who had declined DT LVAD. The themes identified, which could also be considered dialectical tensions, are broadly interpreted under three domains mapping to decision context, process, and outcome: 1) the stark decision context, with tension between hope and reality; 2) the challenging decision process, with tension between wanting loved ones to live and wanting to respect loved ones' wishes; and 3) the downstream decision outcome, with tension between gratitude and burden. Decision making surrounding DT LVAD should incorporate decision support for patients and caregivers. This should include a focus on caregiver burden and the predictable tensions that caregivers experience.