Pre-Ventricular Assist Device Palliative Care Consultation: A Qualitative Analysis
Pre-Ventricular Assist Device Palliative Care Consultation: A Qualitative Analysis
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DOI：
10.1016/j.jpainsymman.2018.09.023
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发表时间：
2019-01-01
影响因子：
4.7
通讯作者：
Wilcox, Jane E.
中科院分区：
文献类型：
--
作者：
Chuzi, Sarah;Hale, Sarah;Wilcox, Jane E.
导论. 2013年，医疗保险和医疗补助服务中心发布了一项命令，要求所有接受目的地治疗心室辅助装置（DT VAD）植入的患者在手术前都可以获得姑息治疗团队。随后，许多VAD项目为考虑DT VAD的患者实施了强制性植入前姑息治疗咨询。然而，很少有人知道这些咨询的质量。纳入了2013年10月30日（医疗保险和医疗补助服务中心决定日期）至2018年3月1日在西北纪念医院接受DT VAD植入术的所有患者。并对安宁疗护会诊记录中的“安宁疗护评估”与“准备计画”进行定性分析。68植入前姑息治疗咨询进行了分析。五十六%的咨询发生在重症监护室，从咨询到VAD植入的中位时间为6天。一般姑息治疗元素很少讨论。此外，仅在10%、54%、49%和12%的咨询中讨论了准备计划的要素--设备故障、VAD后与健康相关的生活质量、设备并发症和进行性合并症。结论。在我们机构进行的一次性着床前姑息治疗咨询不会导致完成准备计划，甚至不会完成一般姑息治疗评估。需要进一步的工作，以确定最有效的方式将姑息治疗纳入植入前护理。(C)2018年美国临终关怀和姑息医学学会。爱思唯尔公司出版All rights reserved.
Introduction. In 2013, the Centers for Medicare and Medicaid Services issued a mandate requiring that all patients undergoing destination therapy ventricular assist device (DT VAD) implantation have access to a palliative care team before surgery. Subsequently, many VAD programs implemented a mandatory preimplantation palliative care consultation for patients considering DT VAD. However, little is known about the quality of these consults.Methods. All patients undergoing DT VAD implantation at Northwestern Memorial Hospital from October 30, 2013 (the Centers for Medicare and Medicaid Services decision date), through March 1, 2018, were included. Palliative care consultation notes were qualitatively analyzed for elements of "palliative care assessment" and preparedness planning.Results. Sixty-eight preimplantation palliative care consultations were analyzed. Fifty-six percent of the consults occurred in the intensive care unit, and the median time from consult to VAD implant was six days. General palliative care elements were infrequently discussed. Furthermore, the elements of preparedness planning-device failure, post-VAD health-related quality of life, device complications, and progressive comorbidities-were discussed in only 10%, 54%, 49%, and 12% of consultations, respectively.Conclusions. One-time preimplantation palliative care consultations at our institution do not lead to completion of preparedness planning or even general palliative care assessment. Further work is needed to determine the most effective way to integrate palliative care into preimplantation care. (C) 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.