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DiMauro PK. Clinical Recommendations for Improving Palliative Nursing Care for Patients With a Left Ventricular Assist Device. J Hosp Palliat Nurs 2024; 26:231-237. [PMID: 38885421 DOI: 10.1097/njh.0000000000001039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Nurses who care for patients with a left ventricular assist device (LVAD) are highly skilled clinicians who manage unique technological demands and complex complications within this specialized patient population. There is a demonstrated need and benefit for palliative care for patients with a LVAD, yet palliative consults are often underused, and the quality of consultation for these patients is poorly understood. Rarely, if at all, do nurses receive formal training on how to navigate the palliative care needs of patients with a LVAD, which includes preparedness planning, caregiver support, device/body image acceptance, and end-of-life care. In addition, there is a need for literature to address specifically how nurses in their role and scope of practice can improve palliative care for patients with a LVAD. The purpose of this article was to present recommendations to equip palliative care nurses to best serve the needs of patients with a LVAD, wherein they can partner with and advance their colleagues in cardiology to improve their delivery of primary palliative care.
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Affiliation(s)
- Pierce K DiMauro
- Pierce K. DiMauro, MSN, RN, is DNP candidate and palliative care DNP fellow, Columbia University School of Nursing, New York, NY
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Pfahl J, Thompson JS, Matlock DD, Allen LA, Dionne-Odom JN, Bakitas MA, McIlvennan CK. ENABLE-LVAD: Development and Implementation of a Novel Training Program for Clinicians Supporting Family Caregivers of Patients With a Left Ventricular Assist Device. J Cardiovasc Nurs 2024; 39:E136-E139. [PMID: 37974325 DOI: 10.1097/jcn.0000000000001065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND Despite significant family caregiver (FCG) burnout, there are currently no tested interventions to support the FCG role after left ventricular assist device (LVAD) implantation or formalized training for clinicians to support FCGs. OBJECTIVE We adapted the existing ENABLE (Educate, Nurture, Advise Before Life Ends) intervention to LVAD clinicians and FCGs and assessed clinical implementation and dissemination. METHODS ENABLE-LVAD is an interactive, self-paced clinician training coupled with FCG-facing guidebooks and resources. Implementation and dissemination were evaluated by the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. RESULTS As of May 2023, 187 clinicians registered for the training, and 41 completed all modules (22.0% completion rate). Of those who completed the training and responded to a 6-month survey, one-third (n = 10, 33.3%) used ENABLE-LVAD with FCGs, and 100% of those planned to continue using it. The primary barrier to completing the training was time. CONCLUSIONS The ENABLE-LVAD clinician training was successfully disseminated and implemented as a useful resource to support LVAD FCGs.
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Nguyen DD, Spertus JA, Benton MC, Thomas M, Jones PG, Andrei AC, Wu T, Baldridge AS, Grady KL. Association of Patient Reported Outcomes With Caregiver Burden in Older Patients With Advanced Heart Failure: Insights From the SUSTAIN-IT Study. Circ Heart Fail 2024; 17:e011705. [PMID: 38910557 DOI: 10.1161/circheartfailure.124.011705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/03/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Caregivers of patients with advanced heart failure may experience burden in providing care, but whether changes in patient health status are associated with caregiver burden is unknown. METHODS This observational study included older patients (60-80 years old) receiving advanced surgical heart failure therapies and their caregivers at 13 US sites. Patient health status was assessed using the 12-item Kansas City Cardiomyopathy Questionnaire (range, 0-100; higher scores are better). Caregiver burden was assessed using the Oberst Caregiving Burden Scale, which measures time on task (OCBS-time) and task difficulty (OCBS-difficulty; range, 1-5; lower scores are better). Measurements occurred before surgery and 12 months after in 3 advanced heart failure cohorts: patients receiving long-term left ventricular assist device support; heart transplantation with pretransplant left ventricular assist device support; and heart transplantation without pretransplant left ventricular assist device support. Multivariable linear regression was used to identify predictors of change in OCBS-time and OCBS-difficulty at 12 months. RESULTS Of 162 caregivers, the mean age was 61.0±9.4 years, 139 (86%) were female, and 140 (86%) were the patient's spouse. At 12 months, 99 (61.1%) caregivers experienced improved OCBS-time, and 61 (37.7%) experienced improved OCBS-difficulty (versus no change or worse OCBS). A 10-point higher baseline 12-item Kansas City Cardiomyopathy Questionnaire predicted lower 12-month OCBS-time (β=-0.09 [95% CI, -0.14 to -0.03]; P<0.001) and OCBS-difficulty (β=-0.08 [95% CI, -0.12 to -0.05]; P<0.001). Each 10-point improvement in the 12-item Kansas City Cardiomyopathy Questionnaire predicted lower 12-month OCBS-time (β=-0.07 [95% CI, -0.12 to -0.03]; P=0.002) and OCBS-difficulty (β=-0.09 [95% CI, -0.12 to -0.06]; P<0.001). CONCLUSIONS Among survivors at 12 months, baseline and change in patient health status were associated with subsequent caregiver time on task and task difficulty in dyads receiving advanced heart failure surgical therapies, highlighting the potential for serial 12-item Kansas City Cardiomyopathy Questionnaire assessments to identify caregivers at risk of increased burden. REGISTRATION URL: https://www.clinicaltrials.gov; unique identifier: NCT02568930.
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Affiliation(s)
- Dan D Nguyen
- University of Missouri, Kansas City (D.D.N., J.A.S., M.C.B., M.T., P.G.J.)
- Saint Luke's Mid America Heart Institute, Kansas City, MO (D.D.N., J.A.S., M.C.B., M.T., P.J.)
| | - John A Spertus
- University of Missouri, Kansas City (D.D.N., J.A.S., M.C.B., M.T., P.G.J.)
- Saint Luke's Mid America Heart Institute, Kansas City, MO (D.D.N., J.A.S., M.C.B., M.T., P.J.)
| | - Mary C Benton
- University of Missouri, Kansas City (D.D.N., J.A.S., M.C.B., M.T., P.G.J.)
- Saint Luke's Mid America Heart Institute, Kansas City, MO (D.D.N., J.A.S., M.C.B., M.T., P.J.)
| | - Merrill Thomas
- University of Missouri, Kansas City (D.D.N., J.A.S., M.C.B., M.T., P.G.J.)
- Saint Luke's Mid America Heart Institute, Kansas City, MO (D.D.N., J.A.S., M.C.B., M.T., P.J.)
| | - Philip G Jones
- University of Missouri, Kansas City (D.D.N., J.A.S., M.C.B., M.T., P.G.J.)
- Saint Luke's Mid America Heart Institute, Kansas City, MO (D.D.N., J.A.S., M.C.B., M.T., P.J.)
| | - Adin-Cristian Andrei
- Feinberg School of Medicine at Northwestern University, Chicago, IL (A.-C.A., T.W., A.S.B., K.L.G.)
| | - Tingqing Wu
- Feinberg School of Medicine at Northwestern University, Chicago, IL (A.-C.A., T.W., A.S.B., K.L.G.)
| | - Abigail S Baldridge
- Feinberg School of Medicine at Northwestern University, Chicago, IL (A.-C.A., T.W., A.S.B., K.L.G.)
| | - Kathleen L Grady
- Feinberg School of Medicine at Northwestern University, Chicago, IL (A.-C.A., T.W., A.S.B., K.L.G.)
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Bechthold AC, McIlvennan CK, Matlock DD, Ejem DB, Wells RD, LeJeune J, Bakitas MA, Odom JN. "Things That You Thought Mattered, None of That Matters": A Qualitative Exploration of Family Caregiver Values following Left Ventricular Assist Device Implantation. J Cardiovasc Nurs 2024:00005082-990000000-00189. [PMID: 38786984 DOI: 10.1097/jcn.0000000000001105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND Intentional exploration, or elicitation, of patient and family values-who/what matters most-is critical to the delivery of person-centered care, yet the values elicitation experiences of family caregivers have been understudied. Understanding caregiver experiences discussing, reflecting upon, and acting on their values is critical to optimizing health decisions after left ventricular assist device (LVAD) implantation. OBJECTIVE The aim of this study was to explore the values elicitation experiences of family caregivers of individuals with an LVAD in the postimplantation period. METHODS This was a qualitative descriptive study of LVAD caregivers recruited from an outpatient clinic in the southeast United States. After completing one-on-one semistructured interviews, participants' transcripts were analyzed using thematic analysis. RESULTS Interviewed caregivers (n = 21) were 27 to 76 years old, with 67% African American, 76% female, 76% urban-dwelling, and 62% a spouse/partner. LVAD implantation was an impactful experience prompting caregiver reevaluation of their values; these values became instrumental to navigating decisions and managing stressors from their caregiving role. Three broad themes of caregiver values elicitation experiences emerged: (1) caregivers leverage their values for strength and guidance in navigating their caregiving role, (2) LVAD implantation prompts (re)evaluation of relationships and priorities, and (3) caregivers convey their goals and priorities when deemed relevant to patient care. CONCLUSIONS Having a care recipient undergo LVAD implantation prompted caregivers to reevaluate their values, which were used to navigate caregiving decisions and stressors. Findings highlight the need for healthcare professionals to engage and support caregivers after LVAD implantation.
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D'Andria Ursoleo J, Pieri M, Calvo F, Altizio S, Gramegna M, Pontillo D, Ajello S, Scandroglio AM. Long-term quality of life, psychological distress, and caregiver burden in octogenarians with LVAD: A single-centre experience. Int J Artif Organs 2024; 47:303-308. [PMID: 38520143 DOI: 10.1177/03913988241239236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
With the general population aging, both life expectancy and the number of left ventricular assist device (LVAD) implantations in elderly patients are growing. Nevertheless, their perceived long-term quality of life, including psychological aspects, coupled with the respective caregiver's burden, remain under-reported. In light of the rising number of octogenarians with LVAD who necessitate broader healthcare provider involvement, we assessed the long-term quality of life, as defined by both the 36-item short-form health (SF-36) survey and the EuroQol 5 dimensions, 5-level questionnaire (EQ-5D-5L)-including the visual analog scale-in octogenarian LVAD patients who had received treatment at our institution. Additionally, we evaluated the psychological health of octogenarian LVAD patients using the psychological general well-being index (PGWBI), alongside their caregivers' well-being through the 22-item version of the Zarit Burden Interview (ZBI). Of 12 octogenarian LVAD patients, 5 were alive and willing to answer questionnaires. Mean age at implant was 74 ± 2 years. Median follow-up was 2464 (IQR = 2375-2745) days. Although variable, the degree of health and psychological well-being perceived by octogenarian patients with LVAD was "good." Interestingly, the burden of assistance reported by caregivers, though relevant, was greatly varied, suggesting the need to better define and address psychological long-term aspects related to LVAD implantation for both patients and caregivers with a broad-spectrum approach.
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Affiliation(s)
- Jacopo D'Andria Ursoleo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Lombardia, Italy
| | - Marina Pieri
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Lombardia, Italy
- Vita-Salute San Raffaele University, Milan, Lombardia, Italy
| | - Francesco Calvo
- Department of Acute Cardiac Care, IRCCS San Raffaele Scientific Institute, Milan, Lombardia, Italy
| | - Savino Altizio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Lombardia, Italy
| | - Mario Gramegna
- Department of Acute Cardiac Care, IRCCS San Raffaele Scientific Institute, Milan, Lombardia, Italy
| | - Domenico Pontillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Lombardia, Italy
| | - Silvia Ajello
- Department of Acute Cardiac Care, IRCCS San Raffaele Scientific Institute, Milan, Lombardia, Italy
| | - Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Lombardia, Italy
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Yoo HJ, Shim J, Kim MS. Validity and reliability of the self-care behaviour scale for patients with left ventricular assist device. Nurs Open 2024; 11:e2102. [PMID: 38530867 DOI: 10.1002/nop2.2102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 12/27/2023] [Accepted: 01/05/2024] [Indexed: 03/28/2024] Open
Abstract
AIMS To evaluate the validity and reliability of the self-care behaviour scale for patients with left ventricular assist devices. DESIGN Methodological study. METHODS The English version of the scale was translated into Korean, and it was then back-translated into English. Survey data were collected from 32 patients with left ventricular assist device in South Korea, and construct validity, content validity and reliability were analysed. RESULTS The original self-care behaviour scale comprises three domains and 33 items, whereas the Korean self-care behaviour scale comprises 27 items and five domains: device management, wound management, symptom monitoring, activated healthcare system and self-care management. Cronbach's alpha for the overall scale was 0.94, and that for the five domains ranged from 0.36 to 0.90. The intraclass correlation coefficient for the overall scale was 0.89, and the five domains ranged from 0.71 to 0.88. CONCLUSION The newly evaluated scale would be valid and reliable in measure self-care behaviour for patients with a left ventricular assist device. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Patients can manage the left ventricular assist device on their own based on evidence and use it as a tool for effective communication with medical professionals.
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Affiliation(s)
- Hye Jin Yoo
- College of Nursing, Dankook University, Cheonan, South Korea
| | - JaeLan Shim
- College of Nursing, Dongguk University, Gyeongju, South Korea
| | - Min-Seok Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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El Zein S, Fawaz M, Al-Shloul MN, Rayan A, ALBashtawy MS, Khader IA, Jallad M, Al-Kharabsheh M, ALBashtawy S, Alshloul DM. Perceptions of Bedside Nurses Caring for Patients with Left Ventricular Assist Devices (LVAD): A Qualitative Study. SAGE Open Nurs 2024; 10:23779608241252249. [PMID: 38746075 PMCID: PMC11092549 DOI: 10.1177/23779608241252249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 03/17/2024] [Accepted: 04/13/2024] [Indexed: 05/16/2024] Open
Abstract
Introduction Bedside nurses in the intensive care units are exposed to multiple challenges in their regular practice and recently have taken in ventricular assist device care in Lebanon since its introduction as a fairly new practice. Objectives To explore the experiences of nursing staff who work in Lebanese hospitals with Left Ventricular Assist Devices (LVAD). Methods This study employed a qualitative phenomenological research design, where semi-structured interviews were carried out among fifteen LVAD nurses in an acute care hospital. Results The qualitative data analysis produced six main themes. The first theme prevalent was "LVAD incompetence and shortage" and it reflected the deficit in properly structured training and the number of specialized LVAD nurses. The second theme that resulted from the analysis was titled, "Patient and family knowledge", which indicated the misconceptions that families and patients usually hold about LVAD which usually sugarcoats the situation. This was followed by "Burden of complications", "LVAD patient selection", "Perception of the LVAD team as invulnerable", and "High workload and patient frailty" which reflected the perspectives of LVAD nurses. Conclusion This study shows that the Lebanese LVAD nurses who participated in this study perceived inadequate competence, yet lacked proper training and induction. The nurses reported multiple challenges relating to care tasks, workload, and patient and family interactions which need to be addressed by coordinators.
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Affiliation(s)
- Sara El Zein
- MSN Student, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
| | - Mirna Fawaz
- Assistant professor, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
| | - Mohammad N. Al-Shloul
- Associated Professor, Applied Medical Sciences Department, Al-Balqa' Applied University, Prince Al Hussein Bin Abdduallah II Academy for Civil Protection, Amman, Jordan
| | - Ahmad Rayan
- Associate professor, Faculty of Nursing, Zarqa University, Zarqa, Jordan
| | - Mohammed S ALBashtawy
- Professor, Department of Community and Mental Health, Princess Salma Faculty of Nursing, AL Al-Bayt University, Mafraq, Jordan
| | - Imad Abu Khader
- Assistance Professor, Adult Health Nursing, Faculty of Graduate Studies Arab American University, Jenin, Palestine
| | - Mohammed Jallad
- Associate Professor, Adult Health Nursing, Faculty of Graduate Studies Arab American University, Jenin, Palestine
| | - Muna Al-Kharabsheh
- Assistance Professor, Nursing College, Al-Balqa Applied University, Salt, Jordan
| | | | - Doha M. Alshloul
- Internship Medicine Student, Ministry of Health, Princess Basma Teaching Hospital/Irbid, Irbid, Jordan
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Atila N, Ozsaker E. Depression, anxiety, stress levels, and coping styles of caregivers of patients with left ventricular assist device. Perspect Psychiatr Care 2022; 58:2414-2422. [PMID: 35383942 DOI: 10.1111/ppc.13076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/15/2022] [Accepted: 03/21/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To determine the depression, anxiety, stress (DAS) levels, and coping styles of caregivers of patients with left ventricular assist device (LVAD). DESIGN AND METHODS The sample of the study consisted of 74 caregivers of patients with LVAD. Data were collected using Individual Data Form, DASS 21, and Coping Styles Scale. FINDINGS Depression was found in 67.6%, anxiety in 45.9%, and stress in 50% of the caregivers of patients with LVAD. A significant relationship was found between the sociodemographic characteristics of caregivers, some variables related to the patient and the care process, and coping styles with stress, and DAS levels of caregivers. PRACTICE IMPLICATIONS Considering the variables that may affect the DAS levels of the LVAD caregivers will improve the expected results from the LVAD.
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Affiliation(s)
- Necla Atila
- Intensive Care Unit, Cardiovascular Surgery Clinic, Ege University Hospital, Izmir, Turkey
| | - Esma Ozsaker
- Surgical Nursing Department, Faculty of Nursing, Ege University, Izmir, Turkey
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Varshney AS, DeFilippis EM, Cowger JA, Netuka I, Pinney SP, Givertz MM. Trends and Outcomes of Left Ventricular Assist Device Therapy: JACC Focus Seminar. J Am Coll Cardiol 2022; 79:1092-1107. [PMID: 35300822 DOI: 10.1016/j.jacc.2022.01.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/29/2021] [Accepted: 01/11/2022] [Indexed: 12/27/2022]
Abstract
As the prevalence of advanced heart failure continues to rise, treatment strategies for select patients include heart transplantation or durable left ventricular assist device (LVAD) support, both of which improve quality of life and extend survival. Recently, the HeartMate 3 has been incorporated into clinical practice, the United Network for Organ Sharing donor heart allocation system was revised, and the management of LVAD-related complications has evolved. Contemporary LVAD recipients have greater preoperative illness severity, but survival is higher and adverse event rates are lower compared with prior eras. This is driven by advances in device design, patient selection, surgical techniques, and long-term management. However, bleeding, infection, neurologic events, and right ventricular failure continue to limit broader implementation of LVAD support. Ongoing efforts to optimize management of patients implanted with current devices and parallel development of next-generation devices are likely to further improve outcomes for patients with advanced heart failure.
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Affiliation(s)
- Anubodh S Varshney
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ersilia M DeFilippis
- Columbia University Irving Medical Center, New York, New York, USA. https://twitter.com/ersied727
| | | | - Ivan Netuka
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic. https://twitter.com/netuka_ivan
| | - Sean P Pinney
- University of Chicago Medicine, Chicago, Illinois, USA. https://twitter.com/spinneymd
| | - Michael M Givertz
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Rossi Ferrario S, Panzeri A, Pistono M. Psychological difficulties of LVAD patients and caregivers: A follow up over 1 year from discharge. Artif Organs 2021; 46:479-490. [PMID: 34519060 PMCID: PMC9292387 DOI: 10.1111/aor.14071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/24/2021] [Accepted: 08/31/2021] [Indexed: 12/13/2022]
Abstract
Background After the rehabilitation program, patients with left ventricular assist device (LVAD) are discharged home, but the adaption to the daily life with the implant is challenging, both with practical and psychological consequences. Literature is lacking detailed information about the quality of life of LVAD patients and caregivers after discharge to home. Objective This study aimed at evaluating the post‐discharge outcomes of both LVAD patients and their caregivers in terms of quality of life, affectivity, and psychological health. Methods In this observational follow‐up study, LVAD dyads discharged home from 1 year to 6 years were re‐contacted by phone and received by mail an envelope with self‐report questionnaires. Responses of 39 complete dyads of patients (mean age 68.59 ± 4.31; males: 92.31%) and their caregivers (mean age 61.59 ± 11.64; males: 17.95%) were analyzed. Results Patients and caregivers reported the moderate levels of anxiety, depression, and caregiver strain, and Illness denial and conscious avoidance were associated between them. The couples often reported that the LVAD has impairments for their sleep and for their affective–sexual relationship. Caregivers often reported impairment in social life and self‐care. Discussions Despite the satisfaction for the medical and territorial assistance, patients showed psychological difficulties such as anxious and depressive symptoms and caregivers tend to neglect themselves. Even after a long time from discharge to home, the psychological distress of LVAD patients and caregivers is still considerable. Structured and continuous psychological interventions are required to support their psychological health overtime after the discharge to home.
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Affiliation(s)
- Silvia Rossi Ferrario
- Unit of Psychology-Neuropsychology, IRCCS ICS Maugeri, Institute of Veruno, Veruno, Italy
| | - Anna Panzeri
- Department of General Psychology, University of Padua, Padova, Italy
| | - Massimo Pistono
- Unit of Cardiology, IRCCS ICS Maugeri, Institute of Veruno, Veruno, Italy
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11
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Chuzi S, Ogunseitan A, Cameron KA, Grady K, Schulze L, Wilcox JE. Perceptions of Bereaved Caregivers and Clinicians About End-of-Life Care for Patients With Destination Therapy Left Ventricular Assist Devices. J Am Heart Assoc 2021; 10:e020949. [PMID: 34308687 PMCID: PMC8475670 DOI: 10.1161/jaha.121.020949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/09/2021] [Indexed: 11/26/2022]
Abstract
Background Patients with left ventricular assist devices (LVADs) implanted as destination therapy may receive suboptimal preparation for and care at the end of life, but there is limited understanding of the reasons for these shortcomings. Exploring perceptions of individuals (caregivers and clinicians) who are closely involved in the end-of-life experience with patients with destination therapy LVADs can help identify key opportunities for improving care. Methods and Results We conducted semistructured qualitative interviews with 7 bereaved caregivers of patients with destination therapy LVADs and 10 interdisciplinary LVAD clinicians. Interviews explored perceptions of preparing for end of life, communicating about end of life, and providing and receiving end-of-life care, and were analyzed using a 2-step team-based inductive approach to coding and analysis. Six themes pertaining to end-of-life experiences were derived: (1) timing end-of-life discussions in the setting of unpredictable illness trajectories, (2) prioritizing end-of-life preparation and decision-making, (3) communicating uncertainty while providing support and hope, (4) lack of consensus on responsibility for end-of-life discussions, (5) perception of the LVAD team as invincible, and (6) divergent perceptions of LVAD withdrawal. Conclusions This study revealed 6 unique aspects of end-of-life care for patients with destination therapy LVADs as reported by clinicians and caregivers. Themes coalesced around communication, team-based care, and challenges unique to patients with LVADs at end of life. Programmatic changes may address some aspects, including training clinicians in LVAD-specific communication skills. Other aspects, such as standardizing the role of the palliative care team and developing practical interventions that enable timely advance care planning during LVAD care, will require multifaceted interventions.
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Affiliation(s)
- Sarah Chuzi
- Division of CardiologyDepartment of MedicineFeinberg School of MedicineNorthwestern UniversityChicagoIL
| | - Adeboye Ogunseitan
- Division of Hospital Medicine (Palliative Care)Department of MedicineFeinberg School of MedicineNorthwestern UniversityChicagoIL
| | - Kenzie A. Cameron
- Division of General Internal Medicine and GeriatricsDepartment of MedicineFeinberg School of MedicineNorthwestern UniversityChicagoIL
| | - Kathleen Grady
- Division of CardiologyDepartment of MedicineFeinberg School of MedicineNorthwestern UniversityChicagoIL
- Division of Cardiac SurgeryDepartment of SurgeryFeinberg School of MedicineNorthwestern UniversityChicagoIL
| | - Lauren Schulze
- Division of Cardiac SurgeryDepartment of SurgeryFeinberg School of MedicineNorthwestern UniversityChicagoIL
| | - Jane E. Wilcox
- Division of CardiologyDepartment of MedicineFeinberg School of MedicineNorthwestern UniversityChicagoIL
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Neo SHS, Ku JSM, Tan JYT, Yoon S. Lived Experiences and Long-Term Challenges and Needs of Asian Left Ventricular Assist Device Caregivers. Palliat Med Rep 2021; 2:84-92. [PMID: 34223507 PMCID: PMC8241394 DOI: 10.1089/pmr.2021.0001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Caregivers are essential for improved outcomes in patients living with left ventricular assist device (LVAD). There is a paucity of research on a long-term LVAD caregivers' experiences and burdens. Objectives: The aim of this study was to explore long-term challenges and needs of LVAD caregivers in the Asian health care setting. Design: We conducted semistructured interviews with caregivers of patients who were currently or previously living with the LVAD. Settings/Subjects: Caregivers were recruited from the National Heart Centre Singapore. Measurements: Interviews were conducted in English and Chinese. All interviews were transcribed verbatim and analyzed based on grounded theory. Chinese interviews were translated to English before transcription. Results: A multiethnic and multireligious sample of 11 caregivers participated. Median caregiving duration was 45 months. Caregivers described long-term challenges that were multifaceted. Misaligned patient expectations, stigmatization and limited social resources within the family and society affected caregivers' coping. Existing gender roles and spiritual and cultural influences shaped how caregivers appraised, made meaning of caregiving, and assessed support. Long-term caregivers' needs included learning from role models, shifting perspectives, enhancing communication between patient and caregivers, advocacy efforts, and holistic medical care. Conclusions: Gender roles as well as cultural and spiritual influences affected coping and access to support in long-term Asian LVAD caregivers. Future interventions should consider culturally relevant approaches to improve well-being and quality of life of caregivers.
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Affiliation(s)
- Shirlyn Hui Shan Neo
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Jasmine Si Min Ku
- Department of Medical Social Services, National Heart Centre Singapore, Singapore, Singapore
| | - Jasmine Yun Ting Tan
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
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