Publication Date

Spring 2023

Degree Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Robin L. Whitney

Second Advisor

Denise Dawkins

Third Advisor

Dulce E. Alcantara


palliative care, LVAD, left ventricular assist device, script, heart failure, quality improvement


For patients with advanced heart failure (HF) ineligible for or awaiting heart transplantation, left ventricular assist device (LVAD) implantation can be considered. LVADs have helped to improve recipients’ survival rates and quality of life. However, LVAD patients are at risk for complications such as stroke, bleeding, infection, and right ventricular failure. Moreover, events such as end-stage malignancy or progression of a neurodegenerative disorder may occur. Such complications and repeated hospitalizations can pose questions about the acceptability of LVAD therapy. As such, both the Centers for Medicare and Medicaid Services and The Joint Commission require that palliative care (PC) be part of the multidisciplinary team prior to and following VAD placement. However, execution of this mandate is unclear, leaving specifics up to the discretion of individual healthcare facilities. At our facility, all patients being evaluated for LVAD implantation must receive a PC consultation. However, confusion around the objectives and structure of this consultation persists. Therefore, the purpose of this project was to implement an evidence-based, semi-structured script to guide pre-LVAD PC consultations. Training on the script was provided to PC clinicians, and pre- and post-surveys helped to identify whether this script improved confidence in PC clinicians conducting pre-LVAD consultations. Confidence levels remained generally unchanged. However, valuable insight was gained through written feedback. Namely, clinicians felt the script provided structure and guidance but that script verbiage and flow could be improved. Moreover, clinicians expressed that communication from the HF team and a standardized workflow between PC and HF teams would be beneficial.


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