Interprofessional Clinician Perspectives on LVAD Deactivation Compared to Dialysis Discontinuation: A Cross-Sectional Study Using Vignettes.

BACKGROUND

Requests for left ventricular assist device (LVAD) deactivation may pose unique emotional and moral burdens on clinicians.

OBJECTIVES

The authors aimed to explore the perspectives of interprofessional clinicians regarding LVAD deactivation across clinical settings compared to cessation of hemodialysis.

METHODS

Vignette-based interviews were conducted with a sample of interprofessional clinicians at a heart and vascular center from April 14, 2023, to June 5, 2023. Likert-scale responses to paired vignettes were analyzed descriptively and with inferential statistics.

RESULTS

Eighty clinicians agreed to be interviewed for this study (27.5% physicians, 23.8% nurses, 17.5% physician trainees, 16.3% advanced practice providers, and 15% social workers, bioethicists, and chaplains). Clinicians uniformly felt that vignettes depicting LVAD deactivation were more ethically complex and less likely to be honored than dialysis discontinuation across clinical scenarios (P < 0.001). Clinicians were more likely to rate scenarios that described the patient without other medical comorbidities ("tired of life") for either the patient with a LVAD or a patient on dialysis as ethically complex and were less likely to suggest honoring the patient's request (P < 0.001). These trends remained consistent across all demographic and clinician disciplines.

CONCLUSIONS

When compared to requests to discontinue hemodialysis, clinicians perceive LVAD deactivation as more ethically complex and were less likely to honor the patient's request. These differences persisted across clinical scenarios, from acutely ill to chronically ill to independent.