Palliative Medicine and Preparedness Planning for Patients Receiving Left Ventricular Assist Device as Destination Therapy-Challenges to Measuring Impact and Change in Institutional Culture.
Palliative Medicine and Preparedness Planning for Patients Receiving Left Ventricular Assist Device as Destination Therapy-Challenges to Measuring Impact and Change in Institutional Culture.
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DOI：
10.1016/j.jpainsymman.2016.10.372
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发表时间：
2017-08
影响因子：
4.7
通讯作者：
Swetz KM
中科院分区：
文献类型：
--
作者：
Verdoorn BP;Luckhardt AJ;Wordingham SE;Dunlay SM;Swetz KM
虽然左心室辅助装置作为目标治疗 (DT-LVAD) 可以改善精心挑选的晚期心力衰竭患者的生存率、生活质量和功能能力，但在这一人群中提供优质的临终护理仍然存在独特的挑战。普遍建议参与姑息治疗，但如何最好地实施这种护理并衡量成功程度尚不清楚。描述在我们机构接受 DT-LVAD 的患者的准备计划 (PP) 过程，并更好地了解质量改进或程序可转移性的机会。对 2009 年至 2013 年间在同一机构接受 DT-LVAD 植入的 107 名连续患者进行回顾性审查。从医疗记录中提取并分析有关人口统计、预先护理计划和死亡率的信息。研究结果与 PP 发生前在同一机构接受 DT-LVAD 植入的历史队列进行了比较（2003-2009 年）。接受 DT-LVAD 患者的平均年龄为 64.3 岁 (SD±10.7)。在最后一次随访时，46 名患者（43%）死亡。该组 DT-LVAD 后的平均生存期为 1.1 年 (SD±1.2)。 89% 的患者在植入前接受了姑息治疗咨询，70% 的患者完成了 PP。虽然 66% 的患者完成了植入前预先指示 (AD)，但只有 2 个 AD (2.8%) 特别提到 DT-LVAD，并且没有一个 AD 涉及 PP 的核心要素。 AD 完成率比我们实施 PP 政策之前的 47% 有所提高 (P=0.012)。 PP 讨论的严格性与病历中 AD 的内容之间存在明显的脱节。我们敦促未来的努力集中于缩小这一差距。
While 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. 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. 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 prior to the development of PP (2003–2009). 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). 89% of patient had palliative care consultation prior to implantation, and 70% completed PP. While 66% of patients completed an advance directive (AD) preimplantation, only 2 ADs (2.8%) specifically mentioned DT-LVAD and none addressed core elements of PP. AD completion rates improved from 47% prior to our policy on PP (P=0.012). 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.
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影响因子：
8.9
作者：
Feldman, David;Pamboukian, Salpy V.;Rogers, Joseph
通讯作者：
Rogers, Joseph
影响因子：
158.5
作者：
Rose, EA;Gelijns, AC;Meier, P
通讯作者：
Meier, P
影响因子：
4.7
作者：
Swetz, Keith M.;Kamal, Arif H.;Feely, Molly A.
通讯作者：
Feely, Molly A.
影响因子：
6.3
作者：
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通讯作者：
Brown RL
DOI：
10.1016/j.jtcvs.2006.09.124
发表时间：
2008-06-01
影响因子：
6
作者：
Long, James W.;Healy, Aaron H.;Renlund, Dale G.
通讯作者：
Renlund, Dale G.