Session: Clinical Ethics: Appropriateness of Treatment
Clinician Experience of LVAD Deactivation
Thursday, September 19, 2024
10:45 AM – 11:45 AM CT
Location: Midway 9 (First Floor)
Abstract: We sought to understand the experience of clinicians caring for patients who request deactivation of a left ventricular assist device (LVAD) through a mixed methods survey. We asked a random sampling of eighty interdisciplinary clinicians at a heart and vascular institute to rate the ethical complexity of various clinical vignettes about LVAD deactivation compared to discontinuing hemodialysis across varying clinical scenarios. For the qualitative portion, we recorded interviews on zoom and transcripts were analyzed using an inductive, iterative approach based on grounded theory to identify common themes.
Briefly, the clinical scenario and the type of medical technology significantly influenced how ethically complex clinicians found each case and whether they would honor the patient’s request. Thematic analysis revealed several preliminary themes: 1) Patient preference and the limitations of patient preference; 2) Concerns regarding clinician’s legal or professional obligations; 3) Clinician aversion to being causally implicated in the death of the patient; 4) suffering as a justification for deactivation; and 5) clinician worries about harms of LVAD deactivation.
Clinicians rated their experience of LVAD deactivation as different than cessation of hemodialysis across clinical situations. Additionally, clinician experience of LVAD deactivation was significantly impacted by the clinical situation so that the more independent or “well” seeming the patient, the more likely the clinician is to report the patient’s request for deactivation as ethically complex and less likely to honor the request. Qualitative analysis revealed that as the clinical scenario increased in ethical complexity, considerations other than patient preference became more pronounced.
Learning Objectives:
After participating in this conference, attendees should be able to:
Understand the importance of a phenomenological approach to LVAD deactivation.
Analyze a novel mixed methods survey exploring clinician experiences with LVAD deactivation.
Shikha Kapil – Georgetown University / MedStar Health; Michael Pottash – Georgetown University / MedStar Health; Anirudh Rao – Georgetown University / MedStar Health; Angela Villalobos – Georgetown University School of Medicine
