Choices for patients "without a choice": Interviews with patients who received a left ventricular assist device as destination therapy.
BACKGROUND
Patients undergo major physical and psychological changes after implantation of a left ventricular assist device as destination therapy (DT). We sought to qualitatively study outcomes and attitudes of patients after DT.


RESULTS
Ambulatory outpatients with DT at our institution were invited to be interviewed between June and August 2011. In-person interviews were audio-recorded, transcribed, and analyzed qualitatively using thematic analysis. The study included 12 patients (11 men) from the Midwestern United States with a median age of 71.5 years (range, 33-78 years). Interviews were conducted at a median (range) time of 1.37 (0.43-5.04) years after DT implantation. Most patients were white (n=11), married (n=10), and Christian (n=10). We identified 6 themes commonly discussed by the interviewees: preparedness planning, new lease on life, optimizing support networks, systemic limitations, reflections on time, and communication matters. Analysis revealed that most patients saw DT as their only choice, despite other alternatives.


CONCLUSIONS
Ambulatory patients reported varied experiences after DT but commonly reported gratitude for improved functional status and a perception of improved symptom burden. Recommendations for improving post-DT care include developing patient support systems, systematizing education for community providers, and expanding respite services.
From the Program in Professionalism and Ethics (A.L.O., K.E.C., P.S.M.) and Division of General Internal Medicine (K.E.C., R.J.T., L.A.M., P.S.M., K.M.S.), Mayo Clinic, Rochester, MN.
Abigale L
AL
Ottenberg
From the Program in Professionalism and Ethics (A.L.O., K.E.C., P.S.M.) and Division of General Internal Medicine (K.E.C., R.J.T., L.A.M., P.S.M., K.M.S.), Mayo Clinic, Rochester, MN.
Katlyn E
KE
Cook
From the Program in Professionalism and Ethics (A.L.O., K.E.C., P.S.M.) and Division of General Internal Medicine (K.E.C., R.J.T., L.A.M., P.S.M., K.M.S.), Mayo Clinic, Rochester, MN.
Rachel J
RJ
Topazian
From the Program in Professionalism and Ethics (A.L.O., K.E.C., P.S.M.) and Division of General Internal Medicine (K.E.C., R.J.T., L.A.M., P.S.M., K.M.S.), Mayo Clinic, Rochester, MN.
Luke A
LA
Mueller
From the Program in Professionalism and Ethics (A.L.O., K.E.C., P.S.M.) and Division of General Internal Medicine (K.E.C., R.J.T., L.A.M., P.S.M., K.M.S.), Mayo Clinic, Rochester, MN.
Paul S
PS
Mueller
From the Program in Professionalism and Ethics (A.L.O., K.E.C., P.S.M.) and Division of General Internal Medicine (K.E.C., R.J.T., L.A.M., P.S.M., K.M.S.), Mayo Clinic, Rochester, MN. swetz.keith@mayo.edu.
Keith M
KM
Swetz
D000328:Adult; D000368:Aged; D005260:Female; D006353:Heart-Assist Devices / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010465:Perception; D019919:Prosthesis Implantation; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States; D018487:Ventricular Dysfunction, Left / Q000523:psychology / Q000628:therapy*
advance care planning; decision making, shared; ethics, medical; heart-assist devices; palliative care