title: Life in transition: a qualitative study of the illness experience and vocational adjustment of patients with left ventricular assist device.
abstract: BACKGROUND
  A left ventricular assist device (LVAD) is used as a bridge to transplantation in patients with acute heart failure. The device is a major bodily invasion that challenges everyday life. Only few studies have explored the psychosocial adjustments of patients living with an LVAD.
  
  
  OBJECTIVE
  The aim of this study was to explore the lived experience of patients with LVADs.
  
  
  METHODS
  The present study had a qualitative explorative design using in-depth interviews of 10 adult patients that had experienced life with an LVAD from 2008 to 2010 in Denmark. We constructed an interview guide with themes relating to the chronology of the illness trajectory. Data were managed by the qualitative computer package NVivo 8. As a theoretical framework, we chose a life-stage model for the main theme: Life With LVAD. The model describes the developmental tasks in each age group, and we looked at the physical, psychological, social, and vocational adjustments of patients with LVADs.
  
  
  RESULTS
  Despite the suddenness of onset and gravity of illness, the patients in our study coped well with their situation. While bridging to transplantation, the patients experienced the ambivalence of gratitude and frustration toward the LVAD, and during preparation for cardiac transplantation, they experienced the ambivalence of hope and fear. Some resolved their emotional ambiguity by procrastination in relation to vocational adjustments that were necessary due to their illness. Older patients with occupational security were quicker to resume work and everyday life.
  
  
  CONCLUSIONS
  Patients with LVADs succeeded somewhat in reestablishing their lives, but the younger individuals still need to consider vocational options. Some patients need help to get out of the sick role that kept them on disability benefits. The patients all relied on support from close family: parents, spouses, and children.
authors.affiliation: Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark. dorthe.overgaard@rh.regionh.dk
authors.forename: Dorthe
authors.initials: D
authors.lastname: Overgaard
authors.forename: Heidi
authors.initials: H
authors.lastname: Grufstedt Kjeldgaard
authors.forename: Ingrid
authors.initials: I
authors.lastname: Egerod
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D005260:Female; D006353:Heart-Assist Devices / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009790:Occupations; D055815:Young Adult