A randomized controlled pilot trial to improve advance care planning for LVAD patients and their surrogates

Metzger, Maureen; Song, Mi‐Kyung; Ward, Sandra E.; Chang, Patricia P.; Hanson, Laura C.; Lin, Feng

doi:10.1016/j.hrtlng.2016.01.005

Cited by 26 publications

(26 citation statements)

References 40 publications

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“…Four studies used a mixed‐methods design: Salomon, Frankel, Chuang, Eti, and Selwyn (), Nakagawa, Yuzefpolskaya, Colombo, Naka, and Blinderman (), Metzger, Song, Ward, et al () and Metzger Song, and Devane‐Johnson (), Swetz, Freeman, et al (). Metzger, Song, Ward, et al, ; Metzger, Song, & Devane‐Johnson, was published in two parts, separately reporting the results of a randomised controlled trial and a qualitative study. However, here it is reviewed as a single mixed method study, because data for both parts were collected from the same participants during interviews.…”

Section: Resultsmentioning

confidence: 99%

“…Verdoorn et al (); 4. Metzger, Song, Ward, et al ()); Metzger, Song, and Devane‐Johnson ()); 5. Swetz, Freeman, et al ()); 6.…”

Section: Methodsmentioning

confidence: 99%

“…All studies were single-centre and were conducted in the USA. Three studies included DT only Verdoorn, et al (2017) Metzger, Song, Ward, et al (2016) Brush et al (2010, and four studies included patients with LVAD-BTT as well as with DT.…”

Section: Re Sultsmentioning

confidence: 99%

“…Without an understanding of what patients’ preferences would be in a given situation, caregivers of EOL patients with LVAD may experience confusion regarding the dying process, as well as the legal and ethical principles of LVAD deactivation (McIlvennan, Jones, Allen, Nowels, & Matlock, ). Therefore, the treatment delivered in this phase of life might be inconsistent with patients' values (Metzger, Song, Ward, et al, ). Research suggests that the inclusion of planning for an uncertain future in the consent process prior to device implantation can be beneficial for patients and families (Rizzieri et al, ).…”

Section: Introductionmentioning

confidence: 99%

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

Delmaczynska

Newham

2019

Journal of Clinical Nursing

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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.

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Section: Resultsmentioning

confidence: 99%

“…Verdoorn et al (); 4. Metzger, Song, Ward, et al ()); Metzger, Song, and Devane‐Johnson ()); 5. Swetz, Freeman, et al ()); 6.…”

Section: Methodsmentioning

confidence: 99%

Section: Re Sultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Delmaczynska

Newham

2019

Journal of Clinical Nursing

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“…The goal of ACP is to help ensure that people receive medical care that is consistent with their values, goals and preferences during serious and chronic illness 6. In prospective and randomised trials, ACP significantly increases the likelihood that clinicians and SDMs understand and apply a patient’s previously expressed wishes when making medical treatment decisions,7–10 reduces hospitalisation at the end of life, results in less intensive treatments at the end of life (according to patients’ wishes) and increases the use of hospice services 11 12…”

Section: Background Rationalementioning

confidence: 99%

Decision support intervention (Plan Well Guide) for patients and their substitute decision-makers to improve engagement in advance care planning: protocol for a randomised trial

et al. 2019

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ObjectiveThe purpose of this randomised trial is to evaluate the efficacy of a decision support intervention for serious illness decisions (the Plan Well Guide decision aid;www.PlanWellguide.com) in increasing the engagement of substitute decision-makers (SDMs) in the patient’s advance care planning process (ie, ‘ACP engagement’), specifically the SDM’s confidence and readiness for the role in the future.Methods and analysisThis study is a parallel group randomised controlled trial. We aim to enrol 90 participant dyads: patients aged 65 years and older attending outpatient healthcare settings and with indicators they would be at high risk of needing future medical decisions and their SDM. The intervention is the Plan Well Guide decision aid, administered to the patient by a facilitator, with the SDM present. The primary endpoint is change after 3 months in the SDM’s ACP engagement using a validated measure of behavioural change (SDM’s knowledge, contemplation, self-efficacy and readiness) to enact the role. The secondary endpoints are (1) ACP engagement of the patient measured by a validated survey; (2) change in SDM decisional conflict regarding involvement in future decision-making and (3) postintervention patient decisional conflict regarding preference for life-sustaining treatments. Primary and secondary continuous outcomes will be analysed using the linear regression. The mean difference and 95% CIs will be reported.Ethics and disseminationApproval was received August 2017 (2017-3714-GRA) from the Hamilton Integrated Research Ethics Board. We plan to disseminate trial results in peer-reviewed journals, at national and international conferences, and via our web-based knowledge translation platforms.Trial registration numberNCT03239639; Pre-results.

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Advance care planning for adults with heart failure

Nishikawa

Hiroyama

Fukahori

et al. 2020

Cochrane Database of Systematic Reviews

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A randomized controlled pilot trial to improve advance care planning for LVAD patients and their surrogates

Cited by 26 publications

References 40 publications

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

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

Decision support intervention (Plan Well Guide) for patients and their substitute decision-makers to improve engagement in advance care planning: protocol for a randomised trial

Advance care planning for adults with heart failure

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