Standardizing Initial Inpatient Palliative Care Consultations for Patients Receiving Left Ventricular Assist Devices at a Large Urban Hospital.

Abstract

Left ventricular assist devices can improve survival rates and quality of life for individuals with advanced heart failure. However, complications and repeated hospitalizations are common. Palliative care involvement is required before and after left ventricular assist device placement. However, limited guidance on the objectives and structure of palliative care consultation in the left ventricular assist device context has led to variation in how these consultations are conducted and confusion around the consultations' objectives and structure. We piloted and modified an evidence-based, semistructured script to guide pre-left ventricular assist device palliative care consultations. Palliative care clinicians were trained on use of the script. Presurvey and postsurvey were used to examine changes in clinician confidence and assess script acceptability. Script use did not result in changes to clinicians' confidence. Clinicians felt the script provided valuable structure and guidance but suggested improvements to script structure and flow, emphasizing the need for a standardized workflow and closer collaboration between palliative care and heart failure teams.