The Importance of Palliative Counseling
Gummert et al. in their instructive review article (1) are right to emphasize the need for a multidisciplinary approach in evaluating treatment with ventricular assist devices (VAD). We wish to point out the importance of targeted palliative counseling for patients and their relatives (2, 3).
Even though the efficiency of cardiac support systems and associated complication rates have notably improved in recent years, a substantial proportion of patients die within the first year. Many others will develop substantial physical impairments and require round-the-clock care by their relatives. On this background, comprehensive information about the option of palliative care in the sense of best supportive care compared with the opportunities provided and burdens imposed by mechanical cardiac assist systems is of particular importance (for example: www.patientdecisionaid.org/lvad). Advance care planning should be an essential component of the preparations, in which patients articulate their preferences in case of further deterioration of their health and can nominate a proxy for power of attorney to act on their behalf (3).
At this point we would also like to remind readers of the situation that arises when patients express a desire to end their VAD therapy because they no longer experience their quality of life as tolerable (for example, also if they develop a secondary incurable disorder). The associated ethical problems and the great burden on all involved, which arise from the usually rapid death of the patient after the VAD is switched off, require particular attention and a well-coordinated approach that should have been discussed in advance (4).
Dr. med. Christina Gerlach MSc
Prof. Dr. med. Martin Weber
Interdisziplinäre Abteilung für Palliativmedizin, III. Medizinische Klinik
Universitätsmedizin der Johannes Gutenberg-Universität Mainz
Conflict of interest statement
The authors declare that no conflict of interest exists.
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|2.||Salomon S, Frankel H, Chuang E, Eti S, Selwyn P: Implementing routine palliative care consultation before LVAD implantation: a single center experience. J Pain Symptom Manage 2018; 55: 1350–5 CrossRef MEDLINE|
|3.||Warraich HJ, Maurer MS, Patel CB, Mentz RJ, Swetz KM: Top ten tips palliative care clinicians should know about caring for patients with left ventricular assist devices. J Palliat Med 2019; 22: 437–41 CrossRef MEDLINE|
|4.||Brush S, Budge D, Alharethi R, et al.: End-of-life decision making and implementation in recipients of a destination left ventricular assist device. J Heart Lung Transplant 2010; 29: 1337–41 CrossRef MEDLINE|