Ventricular assist devices as destination therapy: psychosocial and ethical implications.
Ventricular assist devices as destination therapy: psychosocial and ethical implications.
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DOI：
10.14797/mdcj-11-1-9
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发表时间：
2015-01-01
影响因子：
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通讯作者：
Bruce, Courtenay R
中科院分区：
文献类型：
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作者：
Grogan, Sherry;Kostick, Kristin;Bruce, Courtenay R
候选评估挑战之一是确定心理社会领域何时以及如何影响短期和长期目标治疗心室辅助装置（DT-VAD）的结果。很少有DT-VAD研究，也没有有效的工具来确定社会心理风险因素。一般做法是借鉴移植文献，这可能不适用于这种独特的设备应用。我们质疑仅对DT-VAD候选者进行移植心理社会评估的相关性，特别是因为这些患者需要一定程度的认知、心理和行为功能来确保适当的VAD长期自我护理。通过“借用”移植文献，我们可能在预评估中遗漏了重要的心理特征，从而低估了与DT-VAD候选人特别相关的重要因素。相反，我们可以通过使用移植标准作为筛选过程的一部分来筛选可能从DT-VAD中获益的候选人。我们使用一个案例研究来说明在DT-VAD人群中衡量社会心理风险因素的一些挑战，并强调需要为DT-VAD患者制定明确的社会心理评估标准。
One of the candidate evaluation challenges is determining when and how psychosocial domains influence short- and long-term destination therapy ventricular assist device (DT-VAD) outcomes. There are very few DT-VAD studies and no validated instruments to identify psychosocial risk factors. General practice is to borrow from the transplant literature, which may not be applicable to this unique device application. We question the relevance of using transplant psychosocial evaluation for patients who are candidates for DT-VAD only, particularly because these patients require a certain level of cognitive, psychological, and behavioral functioning to ensure proper long-term self-care with the VAD. We may be missing important psychological characteristics in our pre-evaluations by "borrowing" from the transplant literature, thereby underplaying significant factors that are especially relevant for DT-VAD candidates. Conversely, we may be screening out candidates who may benefit greatly from DT-VAD by using transplant criteria as part of the screening process. We use a case study to illustrate some of the challenges of weighing psychosocial risk factors in the DT-VAD population and to emphasize the need for developing distinct psychosocial assessment criteria for DT-VAD patients.