Decision Aid for Left Ventricular Assist Device
Can decision aids (DAs) for heart failure (HF) patients considering a destination therapy left ventricular assist device (DT-LVAD) be created?
The study authors developed drafts of paper and video DAs, in accordance with the International Patient Decision Aid Standards guidelines. They iteratively modified the DAs to ensure acceptability using input from patients, caregivers, and clinicians through alpha testing.
The study investigators conducted semi-structured interviews with 24 patients, 20 caregivers, and 24 clinicians (including advanced HF cardiologists, geriatric and palliative medicine physicians, nurse practitioners specializing in the care of patients with LVADs, and a health communication specialist) to assess readability, bias, and usability of the DAs. This feedback allowed the study authors to integrate aspects critical to decision making around highly invasive therapies for life-threatening diseases, including addressing emotion and fear of death. They used gain frames for all options that focus on living, highlighting palliative and hospice care, integrating the caregiver role, and a range of balanced testimonials. They made available the final materials for general use after 19 iterative versions of the paper DA and four versions of the video DA, able for wider use.
The authors concluded that they created the first International Patient Decision Aid Standards—level DAs for DT-LVAD incorporating features to address a spectrum of cognitive, automatic, and emotional aspects of end-of-life decision making.
The authors should be congratulated for developing this outstanding resource for patients and their caregivers given that there are several nuances (including emotional aspects) regarding DT-LVADs that need to be understood. These resources should better help patients and caregivers to make an informed decision regarding a major interventional therapy for an end-stage illness. This improved communication may have implications for health cost savings and patient burden by minimizing implantation of DT-LVADS in patients who are unable to cope with this advanced therapy.
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