Clancy Malachy J, Jessop Amy B, Logerstedt David
Good Shepherd Penn Partners, Philadelphia, PA, USA; Department of Health Policy, University of the Sciences, Philadelphia, PA, USA.
Public Health Program, Western Michigan University, Kalamazoo, MI, USA.
Heart Lung. 2022 Jan-Feb;51:52-58. doi: 10.1016/j.hrtlng.2021.10.002. Epub 2021 Oct 30.
Recommendations exist to guide clinicians on a comprehensive psychosocial (PS) evaluation prior to Mechanical Circulatory Support (MCS) implantation.
Assess adoption, beliefs, methodologies, and barriers to completion of the 2018 ISHLT/APM/AST/ICCAC/STSW Recommendations for Psychosocial evaluation of adult cardiothoracic transplant and long term mechanical circulatory support.
Cross-sectional survey distributed to all 183 implanting LVAD centers in North America via mail and email.
Total of 58 Programs (35.6% response rate) representing 29 states and all regions of the United States responded. Respondents reported implanting 1,183 adults (range 0 - 85; mean = 21.5, SD = 18) in 2018. A majority (n = 55, 94.8%) reported that the 2018 Recommendations were consistent with their clinical practice and most (n = 51, 87.9%) had adopted the recommendations. The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) (n = 25, 47.1%) was the most commonly cited assessment tool in the use, although 15 centers reported utilizing more than one tool during the assessment process. Most common barriers influencing completion of the PS evaluation include patient too ill (total responses = 104), lack of time (total responses = 89), patient poor candidate (total responses = 44), and lack of Insurance coverage/reimbursement (total responses = 41).
The 2018 ISHLT Recommendations for PS evaluation of LVAD Candidates are widely adopted by respondents in clinical practice, although barriers are still reported to their implementation. Additional research is needed to understand strategies to reduce barriers to implementation and maintenance of the recommendations in clinical practice.
现有指南指导临床医生在植入机械循环支持（MCS）之前进行全面的心理社会（PS）评估。
评估2018年国际心脏和肺移植学会（ISHLT）/美国心肺移植医师协会（APM）/美国胸外科医师协会（AST）/国际心肺辅助和心肺康复学会（ICCAC）/美国胸心外科学会（STSW）关于成人胸心移植和长期机械循环支持心理社会评估建议的采用情况、信念、方法及完成评估的障碍。
通过邮件和电子邮件向北美所有183个植入左心室辅助装置（LVAD）的中心进行横断面调查。
共有来自美国29个州及所有地区的58个项目（回复率35.6%）做出回应。受访者报告在2018年共植入1183例成人患者（范围0 - 85例；均值 = 21.5，标准差 = 18）。大多数（n = 55，94.8%）报告称2018年的建议与他们的临床实践一致，且大多数（n = 51，87.9%）已采用这些建议。在使用中，斯坦福移植综合心理社会评估（SIPAT）（n = 25，47.1%）是最常被提及的评估工具，不过有15个中心报告在评估过程中使用了不止一种工具。影响心理社会评估完成的最常见障碍包括患者病情过重（总回复数 = 104）、时间不足（总回复数 = 89）、患者不适合作为候选对象（总回复数 = 44）以及缺乏保险覆盖/报销（总回复数 = 41）。
2018年ISHLT关于LVAD候选者心理社会评估的建议在临床实践中被受访者广泛采用，不过仍有报告称在实施过程中存在障碍。需要进一步开展研究以了解减少临床实践中实施和维持这些建议的障碍的策略。
