Indiana University (IU) School of Medicine, Indianapolis, Indiana; IU Health Physicians, Indianapolis, Indiana.
IU Health Physicians, Indianapolis, Indiana.
J Pain Symptom Manage. 2017 Oct;54(4):583-588. doi: 10.1016/j.jpainsymman.2017.07.021. Epub 2017 Jul 15.
In 2014, Joint Commission recommended palliative care (PC) engagement in ventricular assist device (VAD) implantation as destination therapy. Limited information is available on established PC protocols in the mechanical circulatory support (MCS) population.
The goals of our PC consultation were to document advance care planning (ACP) discussions and designate a surrogate decision maker (SDM) before MCS implantation. A retrospective analysis compared the frequency of PC consults, ACP discussion, and SDM before and after protocol implementation.
A protocol was developed to conduct interdisciplinary PC consultations for the MCS population.
The percentage of PC consults placed before MCS implantation increased from 11 (17.2%) before protocol to 56 (96.6%) after protocol (P < 0.0001) and documented SDM increased from 26 (40.6%) before protocol to 57 (98.3%) after protocol (P < 0.0001).
Close PC/cardiology collaboration can substantially improve ACP discussions and SDM documentation in the MCS population. This multidisciplinary protocol facilitates successful PC consultations.
2014 年，联合委员会建议在心室辅助装置（VAD）植入作为终末期治疗时进行姑息治疗（PC）。在机械循环支持（MCS）人群中，关于既定 PC 方案的信息有限。
我们的 PC 咨询目标是在 MCS 植入前记录预先护理计划（ACP）讨论并指定替代决策人（SDM）。回顾性分析比较了方案实施前后 PC 咨询、ACP 讨论和 SDM 的频率。
制定了针对 MCS 人群的跨学科 PC 咨询方案。
在 MCS 植入前进行 PC 咨询的百分比从方案实施前的 11 例（17.2%）增加到方案实施后的 56 例（96.6%）（P<0.0001），并记录了 SDM 从方案实施前的 26 例（40.6%）增加到方案实施后的 57 例（98.3%）（P<0.0001）。
密切的 PC/心脏病学合作可以大大改善 MCS 人群中的 ACP 讨论和 SDM 记录。这种多学科方案促进了成功的 PC 咨询。
Zotero 插件