title: Self-care and communication issues at the end of life of recipients of a left-ventricular assist device as destination therapy.
abstract: OBJECTIVE
  The purpose of this review is to provide an overview of self- care and communication issues at the end of life of patients with left-ventricular assist devices (LVADs) for destination therapy, based on recent research on end-of-life communication in other diseases.
  
  
  RESULTS
  For many patients with advanced heart failure, LVADs as destination therapy improve survival and quality of life. However, LVADs can be associated with complications, new comorbidities or worsening of previous conditions, resulting in decreased quality of life and limited prognosis, raising the need for planning palliative and end-of-life care. Open communication addressing the consequences of the LVAD implantation for daily life and the future (including advance directives) is advised in different stages of the treatment, involving a multidisciplinary team taking care of these complex patients and their caregivers.
  
  
  CONCLUSIONS
  Healthcare professionals treating patients before and after LVAD implantation need to take an active role in end-of-life discussions and be able to communicate information regarding expected complications, quality of life and prognosis to the patients and caregivers. Research is needed addressing optimal ways and timing of communication with LVAD patients and families.
authors: Heart Failure Unit, Cardiology Department, Rabin Medical Center, Petah Tikva, Tel Aviv University, Israel. bengalt@clalit.org.il
authors: Tuvia
authors: T
authors: Ben Gal
authors: Tiny
authors: T
authors: Jaarsma
mesh_terms: D016223:Advance Directives; D000368:Aged; D017028:Caregivers / Q000193:education* / Q000523:psychology; D003142:Communication; D015897:Comorbidity; D018450:Disease Progression; D006333:Heart Failure / Q000150:complications / Q000523:psychology / Q000534:rehabilitation*; D006353:Heart-Assist Devices / Q000009:adverse effects / Q000523:psychology / Q000592:standards*; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000379:methods* / Q000592:standards; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards; D011368:Professional-Family Relations; D011369:Professional-Patient Relations; D011788:Quality of Life; D012648:Self Care; D019452:Terminally Ill