Choices for Patients “Without a Choice”

Interviews With Patients Who Received a Left Ventricular Assist Device as Destination Therapy

1. Abigale L. Ottenberg, MA,
2. Katlyn E. Cook, BA,
3. Rachel J. Topazian,
4. Luke A. Mueller, BA,
5. Paul S. Mueller, MD, MPH and
6. Keith M. Swetz, MD, MA

+ Author Affiliations

1. From the Program in Professionalism and Ethics (A.L.O., K.E.C., P.S.M.) and Division of General Internal Medicine (K.E.C., R.J.T., L.A.M., P.S.M., K.M.S.), Mayo Clinic, Rochester, MN.

1. Correspondence to Keith M. Swetz, MD, MA, Division of General Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail swetz.keith@mayo.edu

Abstract

Background—Patients undergo major physical and psychological changes after implantation of a left ventricular assist device as destination therapy (DT). We sought to qualitatively study outcomes and attitudes of patients after DT.

Methods and Results—Ambulatory outpatients with DT at our institution were invited to be interviewed between June and August 2011. In-person interviews were audio-recorded, transcribed, and analyzed qualitatively using thematic analysis. The study included 12 patients (11 men) from the Midwestern United States with a median age of 71.5 years (range, 33–78 years). Interviews were conducted at a median (range) time of 1.37 (0.43–5.04) years after DT implantation. Most patients were white (n=11), married (n=10), and Christian (n=10). We identified 6 themes commonly discussed by the interviewees: preparedness planning, new lease on life, optimizing support networks, systemic limitations, reflections on time, and communication matters. Analysis revealed that most patients saw DT as their only choice, despite other alternatives.

Conclusions—Ambulatory patients reported varied experiences after DT but commonly reported gratitude for improved functional status and a perception of improved symptom burden. Recommendations for improving post-DT care include developing patient support systems, systematizing education for community providers, and expanding respite services.

 

 

Key Words:

• advance care planning
• decision making, shared
• ethics, medical
• heart-assist devices
• palliative care

• Received October 8, 2013.
• Accepted February 10, 2014.

• © 2014 American Heart Association, Inc.