title: A randomized controlled pilot trial to improve advance care planning for LVAD patients and their surrogates.
abstract: OBJECTIVE
  To examine feasibility, acceptability and preliminary effects of an advance care planning (ACP) intervention, SPIRIT-HF, in LVAD patients and their surrogates.
  
  
  BACKGROUND
  LVADs may improve HF symptoms but they are not curative. Thus, ACP is needed to prepare patients and surrogates for end-of-life (EOL) decision-making.
  
  
  METHODS
  Bridge to transplant and destination therapy LVAD patient-surrogate dyads were randomized to either SPIRIT-HF or usual care. Percentages of eligible dyads who were enrolled and completed the study determined feasibility. Analysis of interviews with SPIRIT dyads determined acceptability. Group comparisons of dyad congruence, patient's decisional conflict, and surrogate's decision-making confidence determined preliminary effects.
  
  
  RESULTS
  Of 38 eligible dyads, 29 (76%) were enrolled, randomized, and completed the study. The 14 intervention dyads characterized SPIRIT-HF as beneficial. All dyads demonstrated improvement in outcomes. However, SPIRIT-HF dyads tended toward greater congruence on patient EOL treatment goals.
  
  
  CONCLUSIONS
  SPIRIT-HF is feasible and acceptable. Results will inform future trials.
authors.affiliation: University of Virginia School of Nursing, USA. Electronic address: mjm9cd@virginia.edu.
authors.forename: Maureen
authors.initials: M
authors.lastname: Metzger
authors.affiliation: Emory University Nell Hodgson School of Nursing, USA.
authors.forename: Mi-Kyung
authors.initials: MK
authors.lastname: Song
authors.affiliation: University of Wisconsin-Madison School of Nursing, USA.
authors.forename: Sandra
authors.initials: S
authors.lastname: Ward
authors.affiliation: University of North Carolina at Chapel Hill School of Medicine, USA.
authors.forename: Patricia Pat-Yue
authors.initials: PP
authors.lastname: Chang
authors.affiliation: University of North Carolina at Chapel Hill School of Medicine, USA.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Hanson
authors.affiliation: University of North Carolina at Chapel Hill, USA.
authors.forename: Feng-Chang
authors.initials: FC
authors.lastname: Lin
mesh_terms: D000328:Adult; D032722:Advance Care Planning / Q000592:standards*; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000523:psychology / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012189:Retrospective Studies; D013727:Terminal Care / Q000592:standards*
keywords: Advance care planning intervention; End-of-life care; Family members; LVADs; Surrogates