Palliative Care for Patients on Mechanical Circulatory Support

Wordingham, Sara E.; McIlvennan, Colleen K.

doi:10.1001/amajethics.2019.435

Cited by 19 publications

(4 citation statements)

References 18 publications

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“…Initially developed as a bridge to transplantation, MCS currently is used for both short-and longterm support, ranging from hours to years, for a variety of indications and goals of care. 12,13 Overall 2-year survival is 70% among patients receiving MCS 12 ; however, morbidity in the form of debilitating stroke, significant bleeding, and infection continue to be significant barriers and challenges to patients, their families, and clinicians. As such, this relatively new form of life-sustaining therapy may cause high prognostic uncertainty and unacceptable quality of life.…”

mentioning

confidence: 99%

Moral Distress in Clinicians Caring for Critically Ill Patients Who Require Mechanical Circulatory Support

Emple

Fonseca

Nakagawa

et al. 2021

American Journal of Critical Care

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Background Although use of mechanical circulatory support is increasing, it is unclear how providing such care affects clinicians’ moral distress. Objective To measure moral distress among intensive care unit clinicians who commonly care for patients receiving mechanical circulatory support. Methods In this prospective study, the Moral Distress Scale-Revised was administered to physicians, nurses, and advanced practice providers from 2 intensive care units in an academic medical center. Linear regression was used to assess whether moral distress was associated with clinician type, burnout, or desire to leave one’s job. Clinicians’ likelihood of reporting frequent moral distress when caring for patients receiving mechanical circulatory support vs other critically ill patients also was assessed. Results The sample comprised 102 clinicians who had a mean (SD) score of 100.5 (51.6) on the Moral Distress Scale- Revised. After adjustment for clinician characteristics, moral distress was significantly higher in registered nurses than physicians/advanced practice providers (115.9 vs 71.0, P < .001), clinicians reporting burnout vs those who did not (114.7 vs 83.1, P = .003), and those considering leaving vs those who were not (121.1 vs 89.2, P = .001). Clinicians were more likely to report experiencing frequent moral distress when caring for patients receiving mechanical circulatory support (26.5%) than when caring for patients needing routine care (10.8%; P = .004), but less likely than when caring for patients with either chronic critical illness (57.8%) or multisystem organ failure (56.9%; both P < .001). Conclusion Moral distress was high among clinicians who commonly care for patients receiving mechanical circulatory support, suggesting that use of this therapy may affect well-being among intensive care unit clinicians.

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mentioning

confidence: 99%

Moral Distress in Clinicians Caring for Critically Ill Patients Who Require Mechanical Circulatory Support

Emple

Fonseca

Nakagawa

et al. 2021

American Journal of Critical Care

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“…In traditional advanced heart failure centers, the care for these patients was provided by large multidisciplinary teams involving multiple coordinators, nurses, physician assistants, cardiothoracic surgeons, palliative care, and various advanced heart failure specialists. Due to the costs associated with such a large team, LVAD care was historically limited to large, urban medical facilities [15,16]. Post-transplantation inpatient cardiac rehabilitation allows patients to improve their functional status.…”

Section: Traditional Lvad Care Modelmentioning

confidence: 99%

Perspective Chapter: Delivering LVAD Care to the Local Community

Sobieraj¹,

Valone²,

Bhikadiya³

et al. 2023

Ventricular Assist Devices - Advances and Applications in Heart Failure

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Heart failure is a growing pandemic affecting approximately 6.2 million people in the US and 15 million people worldwide. Mechanical circulatory support devices are not only a bridge to transplantation, but have become destination therapy for a large portion of this population. Given its prevalence and high morbidity and mortality leading to significant financial burden on our healthcare system, establishing strategies focused on improving therapeutic outcomes and prognosis should be prioritized. Delivering care to such a large and complex patient population poses unique challenges given the progressive care needs and extensive follow-up. Time and distance traveled are among the limiting factors that disable patients from having access to life sustaining advanced therapies such as the LVAD. This chapter aims to review the traditional care model and expand on the necessary tools and benefits of the LVAD shared care model in delivering care to previously underserved patient populations with advanced heart failure.

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“…The question may arise whether to deactivate these devices or to leave them active until the patient’s death [ 39 , 40 , 41 , 42 ].…”

Section: When Is the Right Moment To Discuss Cardiac Implantable Devi...mentioning

confidence: 99%

Ten Questions and Some Reflections about Palliative Care in Advanced Heart Failure Patients

Romanò

2022

JCM

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Heart failure is a clinical syndrome with increasing prevalence, high morbidity and mortality. It is characterized by high symptom burden, poor quality of life and high economic costs. This implies that the heart failure (HF) patients who receive palliative care (PC) have needs similar to cancer patients, but which are often unmet. This paper analyzes the main unresolved issues regarding the relationship between HF patients and the referral to an early PC program. These issues are presented as ten questions related to which patients should be admitted to PC and at what stage of their disease. Furthermore, the barriers opposing to referral to PC, the role of cardiologists and PC physicians within the care team, the gap between the scientific societies’ suggestions and the real world, the right time to promote patients’ awareness and shared decision making, regarding prognosis, end of life wishes and choices, with reference also to cardiac implantable devices’ deactivation, are discussed. These unresolved questions support the need to reevaluate programs and specific models in achieving equal access to palliative care interventions for HF patients, which is still mainly offered to patients with cancer.

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Palliative Care for Patients on Mechanical Circulatory Support

Cited by 19 publications

References 18 publications

Moral Distress in Clinicians Caring for Critically Ill Patients Who Require Mechanical Circulatory Support

Moral Distress in Clinicians Caring for Critically Ill Patients Who Require Mechanical Circulatory Support

Perspective Chapter: Delivering LVAD Care to the Local Community

Ten Questions and Some Reflections about Palliative Care in Advanced Heart Failure Patients

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