Palliative Medicine Consultation for Preparedness Planning in Patients Receiving Left Ventricular Assist Devices as Destination Therapy

Dying on Dialysis

“…"-is useful in identifying patients for whom it is appropriate to incorporate a shared decisionmaking discussion into the advance care planning process if not already done (7). Investigators at the Mayo Clinic have proposed that patients beginning a life-sustaining treatment for which there is a limited likelihood of longterm benefit undergo "preparedness planning," a proactive approach to advance care planning that determines and documents patients' goals of care under a variety of foreseeable circumstances, including when the patient's condition irreversibly deteriorates (8). Prognostic tools notwithstanding, the role of uncertainty of long-term benefit further justifies preparedness planning.…”

Little Hope for Medical Futility

“…12 When major medical procedures are initiated, there should always be some discussion of when they will be stopped. 13,14 Patients, family, and friends who know that a left ventricular assist device is a destination therapy and that the destination is a grim one or that dialysis when started and helpful will possibly be stopped at some point before death are far more likely to accept the limits of medicine than those who see a technologic treatment started without any mention that it may well be stopped.…”

Failing better: a new paradigm of care

“…Caregivers report psychosocial support needs and assistance navigating the health system [14]. Clinical complexities of medical decision-making and uncertain prognosis necessitate expert communication skills, advance care planning, and for patients being considered for MCS, preparedness planning [15,16]. Even as advanced heart failure therapies such as continuous inotrope infusions and left ventricular assist devices grow in both sophistication and frequency of implementation, heart failure specialists increasingly recognize the limitations of current technologies to fully engage and support their patients through the trajectory of disease.…”