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serious illnesses and how it may pertain to patients with LVADs including loss of control, self-image, dependency, social stigma, anger, abandonment, isolation and thinking about death. Tools to manage psychosocial stressors such as local support groups and the implementation of therapeutic metaphors (the Labyrinth and Butterfly Release Life Transformation Celebration for LVAD patients) will be described in detail. We will discuss the incorporation of our palliative care team in assisting with management of LVAD patients in collaboration with the advanced heart failure team including advanced care planning and assessing psychosocial factors prior to implantation. Through brief case examples from our experience, we will discuss how spirituality has played a role in decision-making for patients as they view their heart as a sacred entity.

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