Pre-Ventricular Assist Device Palliative Care Consultation

A Qualitative Analysis

Sarah Chuzi*, Sarah Hale, Jason Arnold, Amy Zhou, Rebecca Harap, Kathleen L Grady, Jonathan D Rich, Clyde W Yancy, Adeboye Ogunseitan, Eytan Szmuilowicz, Jane E Wilcox

*Corresponding author for this work

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Introduction: In 2013, the Centers for Medicare and Medicaid Services issued a mandate requiring that all patients undergoing destination therapy ventricular assist device (DT VAD) implantation have access to a palliative care team before surgery. Subsequently, many VAD programs implemented a mandatory preimplantation palliative care consultation for patients considering DT VAD. However, little is known about the quality of these consults. Methods: All patients undergoing DT VAD implantation at Northwestern Memorial Hospital from October 30, 2013 (the Centers for Medicare and Medicaid Services decision date), through March 1, 2018, were included. Palliative care consultation notes were qualitatively analyzed for elements of “palliative care assessment” and preparedness planning. Results: Sixty-eight preimplantation palliative care consultations were analyzed. Fifty-six percent of the consults occurred in the intensive care unit, and the median time from consult to VAD implant was six days. General palliative care elements were infrequently discussed. Furthermore, the elements of preparedness planning—device failure, post-VAD health-related quality of life, device complications, and progressive comorbidities—were discussed in only 10%, 54%, 49%, and 12% of consultations, respectively. Conclusions: One-time preimplantation palliative care consultations at our institution do not lead to completion of preparedness planning or even general palliative care assessment. Further work is needed to determine the most effective way to integrate palliative care into preimplantation care.

Original languageEnglish (US)
Pages (from-to)100-107
Number of pages8
JournalJournal of Pain and Symptom Management
Volume57
Issue number1
DOIs
StatePublished - Jan 1 2019

Fingerprint

Heart-Assist Devices
Palliative Care
Referral and Consultation
Centers for Medicare and Medicaid Services (U.S.)
Intensive Care Units
Therapeutics
Quality of Life
Equipment and Supplies

Keywords

  • Palliative care
  • destination therapy
  • heart failure
  • left ventricular assist device

ASJC Scopus subject areas

  • Nursing(all)
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

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title = "Pre-Ventricular Assist Device Palliative Care Consultation: A Qualitative Analysis",
abstract = "Introduction: In 2013, the Centers for Medicare and Medicaid Services issued a mandate requiring that all patients undergoing destination therapy ventricular assist device (DT VAD) implantation have access to a palliative care team before surgery. Subsequently, many VAD programs implemented a mandatory preimplantation palliative care consultation for patients considering DT VAD. However, little is known about the quality of these consults. Methods: All patients undergoing DT VAD implantation at Northwestern Memorial Hospital from October 30, 2013 (the Centers for Medicare and Medicaid Services decision date), through March 1, 2018, were included. Palliative care consultation notes were qualitatively analyzed for elements of “palliative care assessment” and preparedness planning. Results: Sixty-eight preimplantation palliative care consultations were analyzed. Fifty-six percent of the consults occurred in the intensive care unit, and the median time from consult to VAD implant was six days. General palliative care elements were infrequently discussed. Furthermore, the elements of preparedness planning—device failure, post-VAD health-related quality of life, device complications, and progressive comorbidities—were discussed in only 10{\%}, 54{\%}, 49{\%}, and 12{\%} of consultations, respectively. Conclusions: One-time preimplantation palliative care consultations at our institution do not lead to completion of preparedness planning or even general palliative care assessment. Further work is needed to determine the most effective way to integrate palliative care into preimplantation care.",
keywords = "Palliative care, destination therapy, heart failure, left ventricular assist device",
author = "Sarah Chuzi and Sarah Hale and Jason Arnold and Amy Zhou and Rebecca Harap and Grady, {Kathleen L} and Rich, {Jonathan D} and Yancy, {Clyde W} and Adeboye Ogunseitan and Eytan Szmuilowicz and Wilcox, {Jane E}",
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Pre-Ventricular Assist Device Palliative Care Consultation : A Qualitative Analysis. / Chuzi, Sarah; Hale, Sarah; Arnold, Jason; Zhou, Amy; Harap, Rebecca; Grady, Kathleen L; Rich, Jonathan D; Yancy, Clyde W; Ogunseitan, Adeboye; Szmuilowicz, Eytan; Wilcox, Jane E.

In: Journal of Pain and Symptom Management, Vol. 57, No. 1, 01.01.2019, p. 100-107.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Pre-Ventricular Assist Device Palliative Care Consultation

T2 - A Qualitative Analysis

AU - Chuzi, Sarah

AU - Hale, Sarah

AU - Arnold, Jason

AU - Zhou, Amy

AU - Harap, Rebecca

AU - Grady, Kathleen L

AU - Rich, Jonathan D

AU - Yancy, Clyde W

AU - Ogunseitan, Adeboye

AU - Szmuilowicz, Eytan

AU - Wilcox, Jane E

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: In 2013, the Centers for Medicare and Medicaid Services issued a mandate requiring that all patients undergoing destination therapy ventricular assist device (DT VAD) implantation have access to a palliative care team before surgery. Subsequently, many VAD programs implemented a mandatory preimplantation palliative care consultation for patients considering DT VAD. However, little is known about the quality of these consults. Methods: All patients undergoing DT VAD implantation at Northwestern Memorial Hospital from October 30, 2013 (the Centers for Medicare and Medicaid Services decision date), through March 1, 2018, were included. Palliative care consultation notes were qualitatively analyzed for elements of “palliative care assessment” and preparedness planning. Results: Sixty-eight preimplantation palliative care consultations were analyzed. Fifty-six percent of the consults occurred in the intensive care unit, and the median time from consult to VAD implant was six days. General palliative care elements were infrequently discussed. Furthermore, the elements of preparedness planning—device failure, post-VAD health-related quality of life, device complications, and progressive comorbidities—were discussed in only 10%, 54%, 49%, and 12% of consultations, respectively. Conclusions: One-time preimplantation palliative care consultations at our institution do not lead to completion of preparedness planning or even general palliative care assessment. Further work is needed to determine the most effective way to integrate palliative care into preimplantation care.

AB - Introduction: In 2013, the Centers for Medicare and Medicaid Services issued a mandate requiring that all patients undergoing destination therapy ventricular assist device (DT VAD) implantation have access to a palliative care team before surgery. Subsequently, many VAD programs implemented a mandatory preimplantation palliative care consultation for patients considering DT VAD. However, little is known about the quality of these consults. Methods: All patients undergoing DT VAD implantation at Northwestern Memorial Hospital from October 30, 2013 (the Centers for Medicare and Medicaid Services decision date), through March 1, 2018, were included. Palliative care consultation notes were qualitatively analyzed for elements of “palliative care assessment” and preparedness planning. Results: Sixty-eight preimplantation palliative care consultations were analyzed. Fifty-six percent of the consults occurred in the intensive care unit, and the median time from consult to VAD implant was six days. General palliative care elements were infrequently discussed. Furthermore, the elements of preparedness planning—device failure, post-VAD health-related quality of life, device complications, and progressive comorbidities—were discussed in only 10%, 54%, 49%, and 12% of consultations, respectively. Conclusions: One-time preimplantation palliative care consultations at our institution do not lead to completion of preparedness planning or even general palliative care assessment. Further work is needed to determine the most effective way to integrate palliative care into preimplantation care.

KW - Palliative care

KW - destination therapy

KW - heart failure

KW - left ventricular assist device

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DO - 10.1016/j.jpainsymman.2018.09.023

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JO - Journal of Pain and Symptom Management

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SN - 0885-3924

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