Importance of physician-patient communication in cardiovascular care

Excerpt

I recently read a news release entitled “Too Sick to understand: Doctor-Patient device communication falls short.”1 It related to two presentations made at the annual Scientific Meeting of the Heart Failure Society of America in Seattle in September, 2012.2,3 The first study was undertaken in four Destination Left Ventricular Assist Device (LVAD) programs to determine how much candidate patients and their caregivers understood the implications that LVAD implantation has on end-of-life decisions. The study showed that, although the written materials provided to patients and caregivers pre-implantation discuss risks associated with the device, there was little acknowledgment of the considerations patients and their families will encounter in end-of-life care. For some time now, heart failure physicians have recognized the ethical concerns of how a battery powered left ventricular assist device will affect end-of-life decisions. Patients who have these devices implanted need to review and perhaps modify their advance directives. This study, however, showed that only 14% of patients considered how the effects of an LVAD would have on their end-of-life decisions. In interviews conducted by the investigators, patients and caregivers acknowledged being well prepared to live with an LVAD, but there was a clear lack of awareness about how one dies with an implanted LVAD. The authors of the study recommended that “providers should have in-person discussions with their patients about end-of-life planning,” and that “information should be made explicit to patients and their caregivers about the complicated decisions that come about when removal of life-sustaining treatment might be necessary.” They further recommended that providers should present “multiple opportunities and resources for making changes to advance directives.” …