Preparedness planning before mechanical circulatory support: a "how-to" guide for palliative medicine clinicians

J Pain Symptom Manage. 2014 May;47(5):926-935.e6. doi: 10.1016/j.jpainsymman.2013.06.006. Epub 2013 Oct 2.

Abstract

The role of palliative medicine in the care of patients with advanced heart failure, including those who receive mechanical circulatory support, has grown dramatically in the last decade. Previous literature has suggested that palliative medicine providers are well poised to assist cardiologists, cardiothoracic surgeons, and the multidisciplinary cardiovascular team with promotion of informed consent and initial and iterative discussions regarding goals of care. Although preparedness planning has been described previously, the actual methods that can be used to complete a preparedness plan have not been well defined. Herein, we outline several key aspects of this approach and detail strategies for engaging patients who are receiving mechanical circulatory support in preparedness planning.

Keywords: Mechanical circulatory support; advance care planning; end of life; medical ethics; palliative care; preparedness planning; ventricular assist device.

MeSH terms

  • Advance Care Planning* / ethics
  • Aged
  • Comorbidity
  • Cost of Illness
  • Decision Making
  • Equipment Failure
  • Female
  • Heart Failure / epidemiology
  • Heart Failure / psychology
  • Heart Failure / therapy*
  • Heart-Assist Devices* / adverse effects
  • Humans
  • Informed Consent
  • Male
  • Palliative Care / ethics
  • Palliative Care / methods*
  • Palliative Medicine / ethics
  • Palliative Medicine / methods*
  • Physicians* / ethics
  • Quality of Life