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To explore the prevalence and outcomes of advance care planning for patients with left ventricular assist devices: A review.

AIMS AND OBJECTIVES
To explore the prevalence and outcomes of advance care planning for patients with left ventricular assist devices: a review.


BACKGROUND
End-stage heart failure is associated with significant symptom burden at rest. Left ventricular assist devices are not curative; nevertheless, they alleviate symptoms and prolong survival. Evidence suggests that most patients with left ventricular assist devices and their families do not have open discussions regarding end-of-life wishes until catastrophic complications arise. Therefore, it is important to understand reasons for this, so healthcare professionals such as nurses can facilitate the process.


DESIGN
A mixed-studies integrative review with a narrative synthesis of the evidence. PRISMA guidelines were followed for reporting systematic qualitative reviews.


METHOD
A search of four electronic data in January 2018 and a hand search yielded 139 citations; seven studies met the review eligibility criteria. Methodological quality of the selected studies was evaluated, and data were extracted and compiled.


RESULTS
Three themes were identified: prevalence and feasibility of advanced care planning, advance care planning developed for patients with device support, patients' and caregivers' perceptions of advanced care planning discussions. Advanced care planning is underused routinely implemented in left ventricular device centres. Pre-implantation advanced care planning is feasible and results in the highest rate of documented advance decisions which are useful for both patients and their loved ones in cases of complications.


CONCLUSION
Strong evidence that left ventricular assist-specific advanced care planning is recommended for all left ventricular assist device patients to enable their treatment preferences in case of incurable complications. Palliative care services should collaborate with nurses in designing and facilitating advanced care planning for delisted transplant patients. Patients with left ventricular devices awaiting heart transplant and those waiting for myocardium healing are underrepresented in the current studies. Research on the optimal timing of advanced care planning in these groups of patients is indicated.


RELEVANCE FOR CLINICAL PRACTICE
There is a need for improved approaches to advanced care planning for and with people with left ventricular devices.