title: Palliative medicine consultation for preparedness planning in patients receiving left ventricular assist devices as destination therapy.
abstract: OBJECTIVE
  To assess the benefit of proactive palliative medicine consultation for delineation of goals of care and quality-of-life preferences before implantation of left ventricular assist devices as destination therapy (DT).
  
  
  METHODS
  We retrospectively reviewed the cases of patients who received DT between January 15, 2009, and January 1, 2010.
  
  
  RESULTS
  Of 19 patients identified, 13 (68%) received proactive palliative medicine consultation. Median time of palliative medicine consultation was 1 day before DT implantation (range, 5 days before to 16 days after). Thirteen patients (68%) completed advance directives. The DT implantation team and families reported that preimplantation discussions and goals of care planning made postoperative care more clear and that adverse events were handled more effectively. Currently, palliative medicine involvement in patients receiving DT is viewed as routine by cardiac care specialists.
  
  
  CONCLUSIONS
  Proactive palliative medicine consultation for patients being considered for or being treated with DT improves advance care planning and thus contributes to better overall care of these patients. Our experience highlights focused advance care planning, thorough exploration of goals of care, and expert symptom management and end-of-life care when appropriate.
authors.affiliation: Palliative Medicine Program, Division of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA. swetz.keith@mayo.edu
authors.forename: Keith M
authors.initials: KM
authors.lastname: Swetz
authors.forename: Monica R
authors.initials: MR
authors.lastname: Freeman
authors.forename: Omar F
authors.initials: OF
authors.lastname: AbouEzzeddine
authors.forename: Kari A
authors.initials: KA
authors.lastname: Carter
authors.forename: Barry A
authors.initials: BA
authors.lastname: Boilson
authors.forename: Abigale L
authors.initials: AL
authors.lastname: Ottenberg
authors.forename: Soon J
authors.initials: SJ
authors.lastname: Park
authors.forename: Paul S
authors.initials: PS
authors.lastname: Mueller
mesh_terms: D032722:Advance Care Planning; D016223:Advance Directives; D000368:Aged; D003657:Decision Making; D005190:Family; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D010348:Patient Care Team; D011788:Quality of Life; D012017:Referral and Consultation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018487:Ventricular Dysfunction, Left / Q000628:therapy; D018497:Ventricular Dysfunction, Right / Q000628:therapy; D028761:Withholding Treatment