• J Pain Symptom Manage · Jan 2019

    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, and Jane E Wilcox.
    • Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. Electronic address: sarah-chuzi@northwestern.edu.
    • J Pain Symptom Manage. 2019 Jan 1; 57 (1): 100-107.

    IntroductionIn 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.MethodsAll 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.ResultsSixty-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.ConclusionsOne-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.Copyright © 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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