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To explore the prevalence and outcomes of advance care planning for patients with left ventricular assist devices: A review

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  • Ewa Delmaczynska
  • Roger Newham

Abstract

Aims and objectives To explore the prevalence and outcomes of advance care planning for patients with left ventricular assist devices: a review. Background End‐stage heart failure is associated with significant symptom burden at rest. Left ventricular assist devices are not curative; nevertheless, they alleviate symptoms and prolong survival. Evidence suggests that most patients with left ventricular assist devices and their families do not have open discussions regarding end‐of‐life wishes until catastrophic complications arise. Therefore, it is important to understand reasons for this, so healthcare professionals such as nurses can facilitate the process. Design A mixed‐studies integrative review with a narrative synthesis of the evidence. PRISMA guidelines were followed for reporting systematic qualitative reviews. Method A search of four electronic data in January 2018 and a hand search yielded 139 citations; seven studies met the review eligibility criteria. Methodological quality of the selected studies was evaluated, and data were extracted and compiled. Results Three themes were identified: prevalence and feasibility of advanced care planning, advance care planning developed for patients with device support, patients’ and caregivers’ perceptions of advanced care planning discussions. Advanced care planning is underused routinely implemented in left ventricular device centres. Pre‐implantation advanced care planning is feasible and results in the highest rate of documented advance decisions which are useful for both patients and their loved ones in cases of complications. Conclusion Strong evidence that left ventricular assist‐specific advanced care planning is recommended for all left ventricular assist device patients to enable their treatment preferences in case of incurable complications. Palliative care services should collaborate with nurses in designing and facilitating advanced care planning for delisted transplant patients. Patients with left ventricular devices awaiting heart transplant and those waiting for myocardium healing are underrepresented in the current studies. Research on the optimal timing of advanced care planning in these groups of patients is indicated. Relevance for clinical practice There is a need for improved approaches to advanced care planning for and with people with left ventricular devices.

Suggested Citation

  • Ewa Delmaczynska & Roger Newham, 2019. "To explore the prevalence and outcomes of advance care planning for patients with left ventricular assist devices: A review," Journal of Clinical Nursing, John Wiley & Sons, vol. 28(9-10), pages 1365-1379, May.
    • Handle: RePEc:wly:jocnur:v:28:y:2019:i:9-10:p:1365-1379
    DOI: 10.1111/jocn.14748
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    References listed on IDEAS

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    1. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
    2. Alessandro Liberati & Douglas G Altman & Jennifer Tetzlaff & Cynthia Mulrow & Peter C Gøtzsche & John P A Ioannidis & Mike Clarke & P J Devereaux & Jos Kleijnen & David Moher, 2009. "The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-28, July.
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    1. Alessia Martina Trenta & Michela Luciani & Massimo Moro & Sara Patella & Stefania Di Mauro & Ercole Vellone & Davide Ausili, 2022. "Self-care in Adults With a Retro-auricular Left Ventricular Assist Device: An Interpretive Description," Clinical Nursing Research, , vol. 31(3), pages 553-562, March.

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