Adaptation and coping in patients living with an LVAD: A metasynthesis.
Martha Abshire, Roslyn Prichard, Mia Cajita and 2 others
PMID 27342261WHAT IT FOUND
LVAD patients described living with the device as four stages: before implant, hospital, early home, late home.
Routines for device care and daily activities helped patients feel independent, but fear, dependence, body image, intimacy, and lost roles remained hard.
Key findings
01Patients described living with an LVAD as four stages: pre-LVAD, implant hospitalization, early home, and late home.
02Routines for daily activities and learning device skills helped patients feel more independent.
03Emotional adjustment was harder than routines, with fear of device failure, dependence, body image, intimacy, and lost roles recurring.
STILL TO COME
How it was doneWhat they foundWhat it means for OTsWhat it means for RNs
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What it does not show
The synthesis included only seven qualitative studies from single LVAD centers, with 59 patients total, so it may not represent all patients or programs. Most samples were white, educated men, and only 15 women were included, so experiences of women and other groups are limited. No studies included sick or hospitalized LVAD patients, so frequent hospitalization and poor outcomes are not represented. Some studies included patients with pulsatile devices no longer in use, and implant strategy was not compared, so relevance to current destination therapy patients is uncertain. Two UK studies relied on recall after the device was removed, so experiences were retrospective. The studies were convenience samples and the synthesis did not test interventions, so it cannot show what improves coping.
The easy way to misread this
Do not read these themes as evidence that any LVAD education program improves coping or quality of life. The studies described patients' experiences, not tested interventions, and samples were mainly stable, non-hospitalized, white, educated men from single centers.