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Pre-ventricular assist device palliative care consultation : a qualitative analysis
Article indépendant
INTRODUCTION: In 2013 the Centers for Medicare and Medicaid Services (CMS) issued a mandate requiring that all patients undergoing destination therapy ventricular assist device (DT VAD) implantation have access to a palliative care team prior to surgery. Subsequently, many VAD programs implemented a mandatory pre-implantation palliative care consultation for patients considering DT VAD. However, little is known about the quality of these consults.
METHODS: All patients undergoing DT VAD at Northwestern Memorial Hospital from October 30, 2013 (the CMS 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 pre-implantation 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 6 days. General palliative care elements were infrequently discussed. Further, 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 pre-implantation 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 pre-implantation care.
http://dx.doi.org/10.1016/j.jpainsymman.2018.09.023
Voir la revue «JOURNAL OF PAIN AND SYMPTOM MANAGEMENT»
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