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 Enrique Pajaro

Research output: Contribution to journalArticle

3 Scopus citations

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 2019

Keywords

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

ASJC Scopus subject areas

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

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    Woodburn, J. L., Staley, L. L., Wordingham, S. E., Spadafore, J., Boldea, E., Williamson, S., Hollenbach, S., Ross, H. M., Steidley, D. E., & 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