LVAD patients' and surrogates' perspectives on SPIRIT-HF: An advance care planning discussion

Metzger, Maureen; Song, Mi‐Kyung; Devane-Johnson, Stephanie

doi:10.1016/j.hrtlng.2016.05.033

Cited by 18 publications

(46 citation statements)

References 23 publications

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“…Four studies used a mixed‐methods design: Salomon, Frankel, Chuang, Eti, and Selwyn (), Nakagawa, Yuzefpolskaya, Colombo, Naka, and Blinderman (), Metzger, Song, Ward, et al () and Metzger Song, and Devane‐Johnson (), Swetz, Freeman, et al (). Metzger, Song, Ward, et al, ; Metzger, Song, & Devane‐Johnson, was published in two parts, separately reporting the results of a randomised controlled trial and a qualitative study. However, here it is reviewed as a single mixed method study, because data for both parts were collected from the same participants during interviews.…”

Section: Resultsmentioning

confidence: 99%

“…The dyads who participated in ACP meetings demonstrated greater congruence in their care goals than dyads in the control group who received standard care. Patients found it reassuring to confirm that they and their caregivers were “on the same page” (Metzger, Song, & Devane‐Johnson, ).…”

Section: Resultsmentioning

confidence: 99%

“…Brush et al () found that all patients participating in EOL discussion regardless of their decision expressed feeling “relief that a detailed plan for withdrawal of LVAD support was outlined” (Brush et al, , p. 1339). Metzger, Song, and Devane‐Johnson () invited patients to take part in SPIRIT‐HF, an ACP intervention designed for patients with LVAD and their designated surrogate decision‐makers. The dyads in the intervention group participated in structured conversations facilitated by a nurse specialist about the patients’ thoughts and goals of care in various scenarios.…”

Section: Resultsmentioning

confidence: 99%

“…I don't have any qualms about anything now... I knew about it before but I was too afraid (Metzger, Song, & Devane‐Johnson, ).…”

Section: Resultsmentioning

confidence: 99%

“…Verdoorn et al (); 4. Metzger, Song, Ward, et al ()); Metzger, Song, and Devane‐Johnson ()); 5. Swetz, Freeman, et al ()); 6.…”

Section: Methodsmentioning

confidence: 99%

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To explore the prevalence and outcomes of advance care planning for patients with left ventricular assist devices: A review

Delmaczynska

Newham

2019

Journal of Clinical Nursing

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Aims and objectives To explore the prevalence and outcomes of advance care planning for patients with left ventricular assist devices: a review. Background End‐stage heart failure is associated with significant symptom burden at rest. Left ventricular assist devices are not curative; nevertheless, they alleviate symptoms and prolong survival. Evidence suggests that most patients with left ventricular assist devices and their families do not have open discussions regarding end‐of‐life wishes until catastrophic complications arise. Therefore, it is important to understand reasons for this, so healthcare professionals such as nurses can facilitate the process. Design A mixed‐studies integrative review with a narrative synthesis of the evidence. PRISMA guidelines were followed for reporting systematic qualitative reviews. Method A search of four electronic data in January 2018 and a hand search yielded 139 citations; seven studies met the review eligibility criteria. Methodological quality of the selected studies was evaluated, and data were extracted and compiled. Results Three themes were identified: prevalence and feasibility of advanced care planning, advance care planning developed for patients with device support, patients’ and caregivers’ perceptions of advanced care planning discussions. Advanced care planning is underused routinely implemented in left ventricular device centres. Pre‐implantation advanced care planning is feasible and results in the highest rate of documented advance decisions which are useful for both patients and their loved ones in cases of complications. Conclusion Strong evidence that left ventricular assist‐specific advanced care planning is recommended for all left ventricular assist device patients to enable their treatment preferences in case of incurable complications. Palliative care services should collaborate with nurses in designing and facilitating advanced care planning for delisted transplant patients. Patients with left ventricular devices awaiting heart transplant and those waiting for myocardium healing are underrepresented in the current studies. Research on the optimal timing of advanced care planning in these groups of patients is indicated. Relevance for clinical practice There is a need for improved approaches to advanced care planning for and with people with left ventricular devices.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…I don't have any qualms about anything now... I knew about it before but I was too afraid (Metzger, Song, & Devane‐Johnson, ).…”

Section: Resultsmentioning

confidence: 99%

“…Verdoorn et al (); 4. Metzger, Song, Ward, et al ()); Metzger, Song, and Devane‐Johnson ()); 5. Swetz, Freeman, et al ()); 6.…”

Section: Methodsmentioning

confidence: 99%

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To explore the prevalence and outcomes of advance care planning for patients with left ventricular assist devices: A review

Delmaczynska

Newham

2019

Journal of Clinical Nursing

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Effectiveness of an Advance Care Planning Intervention in Adults Receiving Dialysis and Their Families

Song,

Manatunga,

Plantinga

et al. 2024

JAMA Netw Open

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ImportanceEvidence of effectiveness of advance care planning (ACP) strategies for patients receiving dialysis and their families is needed.ObjectivesTo test the effectiveness of an ACP intervention to prepare patients and their surrogates for end-of-life (EOL) decision-making and to improve surrogate bereavement outcomes.Design, Setting, and ParticipantsThis cluster randomized clinical trial, An Effectiveness-Implementation Trial of SPIRIT (Sharing Patients’ Illness Representations to Increase Trust) in ESRD, was conducted from December 2017 to March 2023 and included 42 dialysis clinics in 5 US states (Georgia, New Mexico, North Carolina, Pennsylvania, and Virginia) randomized to provide intervention or usual care. Recruitment was from February 15, 2018, to January 31, 2022, and patient-surrogate dyads were followed up for 21 months (until January 17, 2023) or until patient death.InterventionEach clinic selected 1 or 2 health care workers (eg, nurse practitioner, registered nurse, or social worker) to conduct 45- to 60-minute ACP discussions with dyads in the clinic or remotely. After March 13, 2020 (commencement of the COVID-19 emergency declaration), all discussions were conducted remotely. An ACP summary was placed in patients’ medical records.Main Outcomes and MeasuresThe primary, 2-week preparedness outcomes were dyad congruence on EOL goals of care, patient decisional conflict, surrogate decision-making confidence, and a composite of dyad congruence and surrogate decision-making confidence. Secondary bereavement outcomes were anxiety, depression, and posttraumatic distress 3 months after patient death. To adjust for COVID-19 pandemic effects on bereavement outcomes, a variable to indicate the timing of baseline and 3-month assessment relative to the COVID-19 emergency declaration was created.ResultsOf the 426 dyads enrolled, 231 were in the intervention clinics, and 195 were in the control clinics. Among all dyads, the mean (SD) patient age was 61.9 (12.7) years, and the mean (SD) surrogate age was 53.7 (15.4) years. At 2 weeks, after adjusting for baseline values, dyad congruence (odds ratio [OR], 1.61; 95% CI, 1.12-2.31; P = .001), decisional conflict scores (β, −0.10; 95% CI, −0.13 to −0.07; P &lt; .001), and the composite (OR, 1.57; 95% CI, 1.06-2.34; P = .03) were higher in the intervention group than in the control group. Surrogate decision-making confidence was similar between groups (β, 0.06; 95% CI, −0.01 to 0.13; P = .12). Among 77 bereaved surrogates, after adjusting for baseline values and assessment timing, intervention group anxiety was lower than control group anxiety (β, −1.55; 95% CI, −3.08 to −0.01; P = .05); however, depression (β, −0.18; 95% CI, −2.09 to 1.73; P = .84) and posttraumatic distress (β, −0.96; 95% CI, −7.39 to 5.46; P = .75) were similar.Conclusions and RelevanceIn this randomized clinical trial, the ACP intervention implemented by health care workers at dialysis centers improved preparation for EOL decision-making but showed mixed effectiveness on bereavement outcomes. The ACP intervention implemented in dialysis centers may be an effective strategy to the dyad preparation for end-of-life care as opposed to the current focus on advance directives.Trial RegistrationClinicalTrials.gov Identifier: NCT03138564

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Ethical Challenges in Care of Patients on Mechanical Circulatory Support at End-of-Life

Pak

Jones

Mather

2020

Curr Heart Fail Rep

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LVAD patients' and surrogates' perspectives on SPIRIT-HF: An advance care planning discussion

Cited by 18 publications

References 23 publications

To explore the prevalence and outcomes of advance care planning for patients with left ventricular assist devices: A review

To explore the prevalence and outcomes of advance care planning for patients with left ventricular assist devices: A review

Effectiveness of an Advance Care Planning Intervention in Adults Receiving Dialysis and Their Families

Ethical Challenges in Care of Patients on Mechanical Circulatory Support at End-of-Life

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