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

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• 作者：Maureen Metzger ; PhD ; RN^a ; ^{mjm9cd@virginia.edu" class="auth_mail" title="E-mail the corresponding author} ; Mi-Kyung Song ; PhD ; RN ; FAAN^b ; Sandra Ward ; PhD ; RN ; FAAN^c ; Patricia Pat-Yue Chang ; MD ; MHS^d ; Laura C. Hanson ; MD ; MPH^d ; Feng-Chang Lin ; PhD^e
• 关键词：LVADs ; Surrogates ; Family members ; Advance care planning intervention ; End-of-life care
• 刊名：Heart & Lung: The Journal of Acute and Critical Care
• 出版年：2016
• 出版时间：May-June 2016
• 年：2016
• 卷：45
• 期：3
• 页码：186-192
• 全文大小：353 K

文摘

To examine feasibility, acceptability and preliminary effects of an advance care planning (ACP) intervention, SPIRIT-HF, in LVAD patients and their surrogates.

Background

LVADs may improve HF symptoms but they are not curative. Thus, ACP is needed to prepare patients and surrogates for end-of-life (EOL) decision-making.

Methods

Bridge to transplant and destination therapy LVAD patient-surrogate dyads were randomized to either SPIRIT-HF or usual care. Percentages of eligible dyads who were enrolled and completed the study determined feasibility. Analysis of interviews with SPIRIT dyads determined acceptability. Group comparisons of dyad congruence, patient's decisional conflict, and surrogate's decision-making confidence determined preliminary effects.

Results

Of 38 eligible dyads, 29 (76%) were enrolled, randomized, and completed the study. The 14 intervention dyads characterized SPIRIT-HF as beneficial. All dyads demonstrated improvement in outcomes. However, SPIRIT-HF dyads tended toward greater congruence on patient EOL treatment goals.

Conclusions

SPIRIT-HF is feasible and acceptable. Results will inform future trials.