22 Mar Caregivers and Patients with LVAD Face Confusion Over End of Life Decisions
MedicalResearch.com Interview with:
Colleen K. McIlvennan, DNP, ANP-BC
Assistant Professor of Medicine
Division of Cardiology
Section of Advanced Heart Failure and Transplantation
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: As technology continues to advance, more people are becoming eligible for advanced therapies for end-stage illness. One such therapy, the left ventricular assist device (LVAD) is an option for carefully selected individuals suffering from end-stage heart failure. Use of this innovative technology has expanded from its original indication as a bridge to transplantation to also include destination therapy, in which patients live with the device for the remainder of their lives. Significant focus has been placed on developing and expanding LVAD programs, with less thought about the eventual end-of-life process awaiting patients whose LVAD is indicated for destination therapy.
We performed semi-structured interviews about experiences surrounding end of life with 8 caregivers of patients who died with an LVAD. There was a wide range of case histories represented by these patients; however, three main themes emerged that coalesced around feelings of confusion:
1) the process of death with an LVAD,
2) the legal and ethically permissible care of patients approaching death with an LVAD, and
3) the fragmented integration of palliative and hospice care.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: In our study, caregivers of LVAD patients reported feelings of confusion and abandonment during the end-of-life process. Continued improvement in end-of-life care for patients with LVADs and their loved ones is needed, especially for the destination therapy population. A first step is to develop a consensus among the health care community on how to approach management at the end of life for patients with an LVAD. More important, the time and attention given to these end-of-life complexities during the period before implantation is relatively minimal and must be expanded. Lastly, the integration of palliative care and hospice is essential to improve communication, manage expectations, and facilitate the transition to hospice care when appropriate.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Future initiatives should focus on enhanced education for patients and their loved ones, including the process of death with an LVAD, the decisions patients may face at the end of life, and the availability of palliative care or hospice. In addition, the ideal timing and reiteration of such information needs to be further explored.
MedicalResearch.com: Is there anything else you would like to add?
Response: With any novel, major medical advance comes potentially unforeseen challenges and unintended consequences. Improved education for patients, loved ones, and health care professionals about the complexities LVAD technology presents at the end of life is warranted.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
McIlvennan CK, Jones J, Allen LA, Swetz KM, Nowels C, Matlock DD. Bereaved Caregiver Perspectives on the End-of-Life Experience of Patients With a Left Ventricular Assist Device. JAMA Intern Med.Published online March 21, 2016. doi:10.1001/jamainternmed.2015.8528.
Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.
Colleen K. McIlvennan (2016). Caregivers and Patients with LVAD Face Confusion Over End of Life Decisions MedicalResearch.com