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Discussion of End-of-Life Care helps give
Heart to Patients and Families
Newswise, June 2, 2011--For patients with
severe heart failure, an implanted
mechanical pump known as a Left Ventricular
Assist Device (LVAD) can be a
life-sustaining treatment. Even though the
technology involves risks, few patients and
their families tend to talk explicitly about
the “what ifs” before surgery takes place.
In the June issue of Mayo Clinic
Proceedings, a team of Mayo Clinic
researchers found that careful discussions
at the bedside about patients’ end-of-life
preferences brought relief to families and
eased subsequent medical care.
“Previous studies have looked at the ethics
of LVAD surgery and the role of patient and
family members when it comes to turning the
device off,” says lead author Keith Swetz,
M.D., an internist and specialist in
palliative medicine. “But these are complex
patients and many things can happen.
"To
our knowledge, this was the first study to
investigate how to help patients and
families to be proactive in decision-making
before patients’ quality of life is
compromised.”
The study looked at 19 patients dependent on
LVAD as a long-term survival strategy rather
than as a “bridge” to a heart transplant.
Among them, 13 patients and their families
discussed advanced care wishes with a
palliative care team that included
physicians and social workers.
The study found the conversations provided
guidance when adverse events occurred, such
as when a patient fell after surgery and
suffered brain damage.
The study also found LVAD patients often
presumed family members were aware of their
end-of-life wishes, when, in fact, spouses
and children were grateful to be guided in a
conversation.
The study affirms the effectiveness of
palliative care discussions before LVAD
surgery, and provides guidelines for
clinicians and hospitals about how to
address end-of-life decision-making.
“It can be a tough conversation for families
to have but we found it didn’t cause stress
or loss of hope,” Dr. Swetz says. “Instead,
having the conversation brought relief and
was ultimately reassuring for families and
patients.”
A peer-reviewed journal, Mayo Clinic
Proceedings publishes original articles
and reviews dealing with clinical and
laboratory medicine, clinical research,
basic science research and clinical
epidemiology.
Mayo Clinic Proceedingsis published
monthly by Mayo Foundation for Medical
Education and Research as part of its
commitment to the medical education of
physicians. The journal has been published
for more than 80 years and has a circulation
of 130,000 nationally and internationally.
Articles are available online at www.mayoclinicproceedings.com.
About Mayo Clinic
Mayo Clinic is a nonprofit worldwide leader
in medical care, research and education for
people from all walks of life. For more
information, visit www.mayoclinic.org/about/ and
www.mayoclinic.org/news
.
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