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

Abstract

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.

Self-care in Adults With a Retro-auricular Left Ventricular Assist Device: An Interpretive Description

“…This could be explained by the lacking awareness these people have regarding the palliative nature of the device (Luciani et al, 2020), as if it could completely cure heart failure and therefore make it unnecessary to pay attention to it. This finding reinforces previous studies on the relevance of implementing advanced care planning and self-care education for people with LVADs (Delmaczynska & Newham, 2019) and enriches the comprehension of how personal beliefs affect self-care, in accordance with the theoretical framework of the study (Riegel et al, 2012).…”

Disparities in Palliative and Hospice Care and Completion of Advance Care Planning and Directives Among Non-Hispanic Blacks: A Scoping Review of Recent Literature

“…89 The literature indicates that advance care planning discussions should be integrated into various areas of the healthcare system, such as primary and emergency care, preoperative settings, and intensive care units. [205][206][207] Providers across the spectrum of medical and mental diagnoses are now being tasked with the responsibility of initiating advance care planning conversations with patients and documenting the progress of these conversations in health records. [208][209][210] Over the last 3 decades, issues related to advance directive completion for medical care, have been well examined.…”

Clinical Recommendations for Improving Palliative Nursing Care for Patients With a Left Ventricular Assist Device

“…However, the primary LVAD nurse is a crucial team member who is adept at reinforcing and clarifying themes brought up during palliative care consultation while conversely aiding the cardiology team to optimize cardiac function. 20 Palliative care nurses should emphasize the importance of the primary LVAD nurse and encourage their participation in palliative consultation. Themes of mortality and morbidity often are readdressed multiple times during the postoperative period, and palliative care nurses should be prepared to support their colleagues in cardiology throughout the entire course of the postoperative period.…”