Destination Therapy

Standardizing the Role of Palliative Medicine and Delineating the DT-LVAD Journey

Jennifer L. Woodburn, Linda L. Staley, Sara E. Wordingham, Jenifer Spadafore, Eva Boldea, Samantha Williamson, Sharene Hollenbach, Heather M. Ross, D Eric Steidley, Octavio E. Pajaro

Research output: Contribution to journalArticle

Abstract

Context: Destination therapy (DT) patients face significant challenges as they transition from chronic left ventricular assist device (LVAD) support to comfort-oriented care. Integration of palliative medicine (PM) into the multidisciplinary team is important to facilitate advanced care planning (ACP) and improve quality of life (QoL). Objectives: We evaluated the impact of a structured programmatic approach to the end-of-life (EOL) process in DT patients as measured by QoL surveys and the utilization of ACP. Methods: We instituted a four prong intervention approach: 1) delineated the path from implant to EOL by defining specific stages, including a transitional phase where care limits were agreed upon, 2) standardized the role of PM, 3) held transitional care meetings to support shared decision-making, and 4) held multidisciplinary team debriefings to facilitate communication. Preintervention and postintervention outcomes were measured for patients/caregivers by using the QUAL-E/QUAL-E (family) QoL instrument. Wilcoxon signed-ranks test compared nonparametric variables. Results: All patients (n = 41)/caregivers (n = 28) reported improved QoL measures (patient P = 0.035/caregiver P = 0.046). Preparedness plans increased from 52% to 73% after implementation and advance directives increased from 71% to 83%. Fifty-nine percent of the patients completed an outpatient PM clinic visit; 51% completed/scheduled a second visit. Clinician outcomes improved including satisfaction with multidisciplinary team communication/expectations, ACP processes, and EOL management. Conclusion: A programmatic approach that standardizes the role of PM and delineates the patient's path from implant to EOL improved quality outcomes and increased implementation of ACP. A defined communication process allowed the multidisciplinary team to have a clear patient management approach.

Original languageEnglish (US)
Pages (from-to)330-340.e4
JournalJournal of Pain and Symptom Management
Volume57
Issue number2
DOIs
StatePublished - Feb 1 2019

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Heart-Assist Devices
Quality of Life
Caregivers
Therapeutics
Interdisciplinary Communication
Communication
Advance Directives
Palliative Medicine
Ambulatory Care
Nonparametric Statistics
Decision Making
Outpatients

Keywords

  • advanced care planning
  • destination therapy
  • end of life
  • Heart failure
  • ventricular assist device

ASJC Scopus subject areas

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

Cite this

Woodburn, J. L., Staley, L. L., Wordingham, S. E., Spadafore, J., Boldea, E., Williamson, S., ... Pajaro, O. E. (2019). Destination Therapy: Standardizing the Role of Palliative Medicine and Delineating the DT-LVAD Journey. Journal of Pain and Symptom Management, 57(2), 330-340.e4. https://doi.org/10.1016/j.jpainsymman.2018.11.007

Destination Therapy : Standardizing the Role of Palliative Medicine and Delineating the DT-LVAD Journey. / Woodburn, Jennifer L.; Staley, Linda L.; Wordingham, Sara E.; Spadafore, Jenifer; Boldea, Eva; Williamson, Samantha; Hollenbach, Sharene; Ross, Heather M.; Steidley, D Eric; Pajaro, Octavio E.

In: Journal of Pain and Symptom Management, Vol. 57, No. 2, 01.02.2019, p. 330-340.e4.

Research output: Contribution to journalArticle

Woodburn, JL, Staley, LL, Wordingham, SE, Spadafore, J, Boldea, E, Williamson, S, Hollenbach, S, Ross, HM, Steidley, DE & Pajaro, OE 2019, 'Destination Therapy: Standardizing the Role of Palliative Medicine and Delineating the DT-LVAD Journey', Journal of Pain and Symptom Management, vol. 57, no. 2, pp. 330-340.e4. https://doi.org/10.1016/j.jpainsymman.2018.11.007
Woodburn, Jennifer L. ; Staley, Linda L. ; Wordingham, Sara E. ; Spadafore, Jenifer ; Boldea, Eva ; Williamson, Samantha ; Hollenbach, Sharene ; Ross, Heather M. ; Steidley, D Eric ; Pajaro, Octavio E. / Destination Therapy : Standardizing the Role of Palliative Medicine and Delineating the DT-LVAD Journey. In: Journal of Pain and Symptom Management. 2019 ; Vol. 57, No. 2. pp. 330-340.e4.
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abstract = "Context: Destination therapy (DT) patients face significant challenges as they transition from chronic left ventricular assist device (LVAD) support to comfort-oriented care. Integration of palliative medicine (PM) into the multidisciplinary team is important to facilitate advanced care planning (ACP) and improve quality of life (QoL). Objectives: We evaluated the impact of a structured programmatic approach to the end-of-life (EOL) process in DT patients as measured by QoL surveys and the utilization of ACP. Methods: We instituted a four prong intervention approach: 1) delineated the path from implant to EOL by defining specific stages, including a transitional phase where care limits were agreed upon, 2) standardized the role of PM, 3) held transitional care meetings to support shared decision-making, and 4) held multidisciplinary team debriefings to facilitate communication. Preintervention and postintervention outcomes were measured for patients/caregivers by using the QUAL-E/QUAL-E (family) QoL instrument. Wilcoxon signed-ranks test compared nonparametric variables. Results: All patients (n = 41)/caregivers (n = 28) reported improved QoL measures (patient P = 0.035/caregiver P = 0.046). Preparedness plans increased from 52{\%} to 73{\%} after implementation and advance directives increased from 71{\%} to 83{\%}. Fifty-nine percent of the patients completed an outpatient PM clinic visit; 51{\%} completed/scheduled a second visit. Clinician outcomes improved including satisfaction with multidisciplinary team communication/expectations, ACP processes, and EOL management. Conclusion: A programmatic approach that standardizes the role of PM and delineates the patient's path from implant to EOL improved quality outcomes and increased implementation of ACP. A defined communication process allowed the multidisciplinary team to have a clear patient management approach.",
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AU - Williamson, Samantha

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