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Assessing Palliative Care Utilization by Ventricular Assist Device Patients, Caregivers, and Clinicians: A Systematic Review

Miller, Jennifer (2022) Assessing Palliative Care Utilization by Ventricular Assist Device Patients, Caregivers, and Clinicians: A Systematic Review. Master Essay, University of Pittsburgh.

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Patients living with a ventricular assist device (VAD) face life-threatening challenges that affect their goals of care. Palliative care (PC) is a medical discipline focused on optimizing quality of life and minimizing suffering for those with serious, complex illnesses. In 2013, multiple policies were established to incorporate PC into VAD programs. This systematic review aims to assess the effect of these policies on PC involvement, as well as to identify the utilization and acceptability of PC by VAD patients, caregivers, and clinicians.
This review includes original research published in English between January 1, 2013 and April 12, 2022. All studies included implemented PC into VAD programs. Study participants were VAD patients, caregivers, or VAD clinicians. Medline (Ovid) and PsycInfo (Ovid) databases were searched. The outcomes assessed are VAD patient, caregiver, and clinician utilization and acceptability of PC involvement in VAD patient care.
Of the 191 records identified; 8 studies were included in the review. All studies supported either the feasibility or implementation of PC amongst VAD programs. Specifically, PC was found to improve symptom management, correlated with a lower incidence of invasive procedures, and facilitated advance care planning conversations.
The studies included in the review suggest that the 2013 policies for incorporating PC into VAD patient care were effective and positively impacted VAD patient care. However, the findings suggest that there remain unmet palliative needs for VAD patients. One possibility to address these needs, while accounting for the national PC specialist workforce shortage, is to develop a stepped model where VAD clinicians take on PC responsibility for patients with needs that can be resolved with care that is between a scripted nurse-performed PC visit and a full PC consultation. Limitations of this study are that it is a single person review, only two databases were searched for English-only publications, as well as that no risk of bias, certainty assessment, or meta-analysis were performed. Future studies should investigate the feasibility and acceptance of this model, as well as its effect on patient outcomes.
No financial support was received for this review. This review is not registered.


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Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Miller, Jenniferjnm68@pitt.edujnm680000-0001-9244-7181
ContributionContributors NameEmailPitt UsernameORCID
Thesis advisorBryce, Cindybryce99@pitt.edubryce99UNSPECIFIED
Committee MemberDew, Mary Amandadewma@upmc.edudew1UNSPECIFIED
Committee MemberHickey,
Date: 1 July 2022
Date Type: Completion
Submission Date: 29 May 2022
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 51
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Health Policy & Management
Degree: MHA - Master of Health Administration
Thesis Type: Master Essay
Refereed: Yes
Uncontrolled Keywords: Ventricular Assist Device, VAD, Palliative Care, Mechanical Circulatory Support
Date Deposited: 01 Jul 2022 18:27
Last Modified: 01 Jul 2022 18:27


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