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Bechthold AC, McIlvennan CK, Matlock DD, Ejem DB, Wells RD, LeJeune J, Bakitas MA, Odom JN. "Things That You Thought Mattered, None of That Matters": A Qualitative Exploration of Family Caregiver Values following Left Ventricular Assist Device Implantation. J Cardiovasc Nurs 2024:00005082-990000000-00189. [PMID: 38786984 DOI: 10.1097/jcn.0000000000001105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND Intentional exploration, or elicitation, of patient and family values-who/what matters most-is critical to the delivery of person-centered care, yet the values elicitation experiences of family caregivers have been understudied. Understanding caregiver experiences discussing, reflecting upon, and acting on their values is critical to optimizing health decisions after left ventricular assist device (LVAD) implantation. OBJECTIVE The aim of this study was to explore the values elicitation experiences of family caregivers of individuals with an LVAD in the postimplantation period. METHODS This was a qualitative descriptive study of LVAD caregivers recruited from an outpatient clinic in the southeast United States. After completing one-on-one semistructured interviews, participants' transcripts were analyzed using thematic analysis. RESULTS Interviewed caregivers (n = 21) were 27 to 76 years old, with 67% African American, 76% female, 76% urban-dwelling, and 62% a spouse/partner. LVAD implantation was an impactful experience prompting caregiver reevaluation of their values; these values became instrumental to navigating decisions and managing stressors from their caregiving role. Three broad themes of caregiver values elicitation experiences emerged: (1) caregivers leverage their values for strength and guidance in navigating their caregiving role, (2) LVAD implantation prompts (re)evaluation of relationships and priorities, and (3) caregivers convey their goals and priorities when deemed relevant to patient care. CONCLUSIONS Having a care recipient undergo LVAD implantation prompted caregivers to reevaluate their values, which were used to navigate caregiving decisions and stressors. Findings highlight the need for healthcare professionals to engage and support caregivers after LVAD implantation.
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Chuzi S, Manning K. Integration of palliative care across the spectrum of heart failure care and therapies: considerations, contemporary data, and challenges. Curr Opin Cardiol 2024; 39:218-225. [PMID: 38567949 DOI: 10.1097/hco.0000000000001120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
PURPOSE OF REVIEW Heart failure (HF) is characterized by significant symptoms, compromised quality of life, frequent hospital admissions, and high mortality, and is therefore well suited to palliative care (PC) intervention. This review elaborates the current PC needs of patients with HF across the spectrum of disease, including patients who undergo advanced HF surgical therapies, and reviews the current data and future directions for PC integration in HF care. RECENT FINDINGS Patients with chronic HF, as well as those who are being evaluated for or who have undergone advanced HF surgical therapies such as left ventricular assist device or heart transplantation, have a number of PC needs, including decision-making, symptoms and quality of life, caregiver support, and end-of-life care. Available data primarily supports the use of PC interventions in chronic HF to improve quality of life and symptoms. PC skills and teams may also help address preparedness planning, adverse events, and psychosocial barriers in patients who have had HF surgeries, but more data are needed to determine association with outcomes. SUMMARY Patients with HF have tremendous PC needs across the spectrum of disease. Despite this, more data are needed to determine the optimal timing and structure of PC interventions in patients with chronic HF, left ventricular assist device, and heart transplantation. Future steps must be taken in clinical, research, and policy domains in order to optimize care.
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Affiliation(s)
- Sarah Chuzi
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Katharine Manning
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center
- Section of Palliative Medicine, Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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Stacey D, Lewis KB, Smith M, Carley M, Volk R, Douglas EE, Pacheco-Brousseau L, Finderup J, Gunderson J, Barry MJ, Bennett CL, Bravo P, Steffensen K, Gogovor A, Graham ID, Kelly SE, Légaré F, Sondergaard H, Thomson R, Trenaman L, Trevena L. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2024; 1:CD001431. [PMID: 38284415 PMCID: PMC10823577 DOI: 10.1002/14651858.cd001431.pub6] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
BACKGROUND Patient decision aids are interventions designed to support people making health decisions. At a minimum, patient decision aids make the decision explicit, provide evidence-based information about the options and associated benefits/harms, and help clarify personal values for features of options. This is an update of a Cochrane review that was first published in 2003 and last updated in 2017. OBJECTIVES To assess the effects of patient decision aids in adults considering treatment or screening decisions using an integrated knowledge translation approach. SEARCH METHODS We conducted the updated search for the period of 2015 (last search date) to March 2022 in CENTRAL, MEDLINE, Embase, PsycINFO, EBSCO, and grey literature. The cumulative search covers database origins to March 2022. SELECTION CRITERIA We included published randomized controlled trials comparing patient decision aids to usual care. Usual care was defined as general information, risk assessment, clinical practice guideline summaries for health consumers, placebo intervention (e.g. information on another topic), or no intervention. DATA COLLECTION AND ANALYSIS Two authors independently screened citations for inclusion, extracted intervention and outcome data, and assessed risk of bias using the Cochrane risk of bias tool. Primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were attributes related to the choice made (informed values-based choice congruence) and the decision-making process, such as knowledge, accurate risk perceptions, feeling informed, clear values, participation in decision-making, and adverse events. Secondary outcomes were choice, confidence in decision-making, adherence to the chosen option, preference-linked health outcomes, and impact on the healthcare system (e.g. consultation length). We pooled results using mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs), applying a random-effects model. We conducted a subgroup analysis of 105 studies that were included in the previous review version compared to those published since that update (n = 104 studies). We used Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess the certainty of the evidence. MAIN RESULTS This update added 104 new studies for a total of 209 studies involving 107,698 participants. The patient decision aids focused on 71 different decisions. The most common decisions were about cardiovascular treatments (n = 22 studies), cancer screening (n = 17 studies colorectal, 15 prostate, 12 breast), cancer treatments (e.g. 15 breast, 11 prostate), mental health treatments (n = 10 studies), and joint replacement surgery (n = 9 studies). When assessing risk of bias in the included studies, we rated two items as mostly unclear (selective reporting: 100 studies; blinding of participants/personnel: 161 studies), due to inadequate reporting. Of the 209 included studies, 34 had at least one item rated as high risk of bias. There was moderate-certainty evidence that patient decision aids probably increase the congruence between informed values and care choices compared to usual care (RR 1.75, 95% CI 1.44 to 2.13; 21 studies, 9377 participants). Regarding attributes related to the decision-making process and compared to usual care, there was high-certainty evidence that patient decision aids result in improved participants' knowledge (MD 11.90/100, 95% CI 10.60 to 13.19; 107 studies, 25,492 participants), accuracy of risk perceptions (RR 1.94, 95% CI 1.61 to 2.34; 25 studies, 7796 participants), and decreased decisional conflict related to feeling uninformed (MD -10.02, 95% CI -12.31 to -7.74; 58 studies, 12,104 participants), indecision about personal values (MD -7.86, 95% CI -9.69 to -6.02; 55 studies, 11,880 participants), and proportion of people who were passive in decision-making (clinician-controlled) (RR 0.72, 95% CI 0.59 to 0.88; 21 studies, 4348 participants). For adverse outcomes, there was high-certainty evidence that there was no difference in decision regret between the patient decision aid and usual care groups (MD -1.23, 95% CI -3.05 to 0.59; 22 studies, 3707 participants). Of note, there was no difference in the length of consultation when patient decision aids were used in preparation for the consultation (MD -2.97 minutes, 95% CI -7.84 to 1.90; 5 studies, 420 participants). When patient decision aids were used during the consultation with the clinician, the length of consultation was 1.5 minutes longer (MD 1.50 minutes, 95% CI 0.79 to 2.20; 8 studies, 2702 participants). We found the same direction of effect when we compared results for patient decision aid studies reported in the previous update compared to studies conducted since 2015. AUTHORS' CONCLUSIONS Compared to usual care, across a wide variety of decisions, patient decision aids probably helped more adults reach informed values-congruent choices. They led to large increases in knowledge, accurate risk perceptions, and an active role in decision-making. Our updated review also found that patient decision aids increased patients' feeling informed and clear about their personal values. There was no difference in decision regret between people using decision aids versus those receiving usual care. Further studies are needed to assess the impact of patient decision aids on adherence and downstream effects on cost and resource use.
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Affiliation(s)
- Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | | | - Meg Carley
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Robert Volk
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elisa E Douglas
- Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Michael J Barry
- Informed Medical Decisions Program, Massachusetts General Hospital, Boston, MA, USA
| | - Carol L Bennett
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Paulina Bravo
- Education and Cancer Prevention, Fundación Arturo López Pérez, Santiago, Chile
| | - Karina Steffensen
- Center for Shared Decision Making, IRS - Lillebælt Hospital, Vejle, Denmark
| | - Amédé Gogovor
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec, Canada
| | - Ian D Graham
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Canada
| | - Shannon E Kelly
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Université Laval, Quebec, Canada
| | | | - Richard Thomson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Logan Trenaman
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
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Rapelli G, Giusti EM, Donato S, Parise M, Pagani AF, Pietrabissa G, Bertoni A, Castelnuovo G. “The heart in a bag”: The lived experience of patient-caregiver dyads with left ventricular assist device during cardiac rehabilitation. Front Psychol 2023; 14:1116739. [PMID: 37089738 PMCID: PMC10114412 DOI: 10.3389/fpsyg.2023.1116739] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/17/2023] [Indexed: 03/12/2023] Open
Abstract
ObjectiveThe Left Ventricular Assist Device (LVAD) has increasingly become a primary therapeutic option for longer-waiting heart transplant lists. Although survival rates are growing, the device requires complex home care. Therefore, the presence of a caregiver trained in the LVAD management is important for the success of the therapy. The LVAD leads both patients and their caregivers to experience new challenges and adapt to new lifestyle changes and limitations – but their subjective beliefs before home management remained little explored.DesignThis study identified, using a phenomenological hermeneutic approach, the main components of the LVAD experience of six patient-caregiver dyads interviewed during cardiac rehabilitation.ResultsWe identified 4 master themes: Being between life and death, Being human with a heart of steel, Sharing is caring (and a burden), and Being small and passive.ConclusionThe knowledge from this study can be used as a guide for healthcare providers in counseling LVAD recipients and their caregivers.
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Affiliation(s)
- Giada Rapelli
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Emanuele Maria Giusti
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Lombardy, Italy
| | - Silvia Donato
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Miriam Parise
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | | | - Giada Pietrabissa
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Lombardy, Italy
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
- *Correspondence: Giada Pietrabissa,
| | - Anna Bertoni
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Lombardy, Italy
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
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Assessment of Caregiver Burden Prior to Implantation of Left Ventricular Assist Device: A National Survey. J Heart Lung Transplant 2023; 42:689-692. [PMID: 36973094 DOI: 10.1016/j.healun.2023.02.1501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 01/24/2023] [Accepted: 02/22/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Guidelines recommend incorporation of caregiver burden assessment and list significant caregiver burden as a relative contraindication when considering left-ventricular assist device (LVAD) implantation. METHODS To assess national practices regarding caregiver burden assessment, in 2019 we administered a 47-item survey to LVAD clinicians using 4 convenience samples. RESULTS Responses were obtained from 191 registered nurses, 109 advance practice providers, 71 physicians, 59 social workers, and 40 others representing 132 LVAD programs; 125 of 173 total United States programs were included in the final analysis. While most programs (83.2%) assessed caregiver burden, assessment was most frequently conducted informally during social work evaluation (83.2%), with only 8.8% incorporating validated measures of caregiver burden. Larger programs were more likely to use a validated assessment measure (OR 6.68 [1.33-33.52]). CONCLUSIONS Future research should focus on how programs can standardize caregiver burden assessment and how the level of burden may impact patient and caregiver outcomes.
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Hollander SA, Pyke-Grimm KA, Shezad MF, Zafar F, Cousino MK, Feudtner C, Char DS. End-of-Life in Pediatric Patients Supported by Ventricular Assist Devices: A Network Database Cohort Study. Pediatr Crit Care Med 2023; 24:41-50. [PMID: 36398973 DOI: 10.1097/pcc.0000000000003115] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Most pediatric patients on ventricular assist device (VAD) survive to transplantation. Approximately 15% will die on VAD support, and the circumstances at the end-of-life are not well understood. We, therefore, sought to characterize patient location and invasive interventions used at the time of death. DESIGN Retrospective database study of a cohort meeting inclusion criteria. SETTING Thirty-six centers participating in the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) Registry. PATIENTS Children who died on VAD therapy in the period March 2012 to September 2021. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of the 117 of 721 patients (16%) who died on VAD, the median (interquartile range) age was 5 years (1-16 yr) at 43 days (17-91 d) postimplant. Initial goals of therapy were bridge to consideration for candidacy for transplantation in 60 of 117 (51%), bridge to transplantation in 44 of 117 (38%), bridge to recovery 11 of 117 (9%), or destination therapy (i.e., VAD as the endpoint) in two of 117 (2%). The most common cause of death was multiple organ failure in 35 of 117 (30%), followed by infection in 12 of 117 (10%). Eighty-five of 92 (92%) died with a functioning device in place. Most patients were receiving invasive interventions (mechanical ventilation, vasoactive infusions, etc.) at the end of life. Twelve patients (10%) died at home. CONCLUSIONS One-in-six pediatric VAD patients die while receiving device support, with death occurring soon after implant and usually from noncardiac causes. Aggressive interventions are common at the end-of-life. The ACTION Registry data should inform future practices to promote informed patient/family and clinician decision-making to hopefully reduce suffering at the end-of-life.
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Affiliation(s)
- Seth A Hollander
- Department of Pediatrics (Cardiology), Stanford University, Palo Alto, CA
| | - Kimberly A Pyke-Grimm
- Departments of Pediatrics (Hematology/Oncology), and Nursing Research and Evidence-Based Practice, Stanford University, Palo Alto, CA
| | - Muhammad F Shezad
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Farhan Zafar
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Melissa K Cousino
- Departments of Pediatrics and Cardiac Surgery, University of Michigan, Ann Arbor, MI
| | - Chris Feudtner
- Department of Pediatrics (General Pediatrics), Children's Hospital of Philadelphia, Philadelphia, PA
| | - Danton S Char
- Department of Anesthesia (Pediatric Cardiac), Stanford University, Palo Alto, CA
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Knoepke CE, Wallace BC, Allen LA, Lewis CL, Gupta SK, Peterson PN, Kramer DB, Brancato SC, Varosy PD, Mandrola JM, Tzou WS, Matlock DD. Experiences Implementing a Suite of Decision Aids for Implantable Cardioverter Defibrillators: Qualitative Insights From the DECIDE-ICD Trial. Circ Cardiovasc Qual Outcomes 2022; 15:e009352. [PMID: 36378770 PMCID: PMC9680003 DOI: 10.1161/circoutcomes.122.009352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/05/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Shared decision making (SDM) is gaining importance in cardiology, including Centers for Medicare & Medicaid Services (CMS) reimbursement policies requiring documented SDM for patients considering primary prevention implantable cardioverter defibrillators. The DECIDE-ICD Trial (Decision Support Intervention for Patients offered implantable Cardioverter-Defibrillators) assessed the implementation and effectiveness of patient decision aids (DAs) using a stepped-wedge design at 7 sites. The purpose of this subanalysis was to qualitatively describe electrophysiology clinicians' experience implementing and using the DAs. METHODS This included semi-structured individual interviews with electrophysiology clinicians at participating sites across the US, at least 6 months following conversion into the implementation phase of the trial (from June 2020 through February 2022). The interview guide was structured according to the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance [implementation evaluation model]) framework, assessing clinician experiences, which can impact implementation domains, and was qualitatively assessed using a mixed inductive/deductive method. RESULTS We completed 22 interviews post-implementation across all 7 sites. Participants included both physicians (n=16) and other clinicians who counsel patients regarding treatment options (n=6). While perception of SDM and the DA were positive, participants highlighted reasons for uneven delivery of DAs to appropriate patients. The CMS mandate for SDM was not universally viewed as associating with patients receiving DA's, but rather (1) logistics of DA delivery, (2) perceived effectiveness in improving patient decision-making, and (3) match of DA content to current patient populations. Remaining tensions include the specific trial data used in DAs and reconciling timing of delivery with when patients are actively making decisions. CONCLUSIONS Clinicians charged with delivering DAs to patients considering primary prevention implantable cardioverter defibrillators were generally supportive of the tenets of SDM, and of the DA tools themselves, but noted several opportunities to improve the reach and continued use of them in routine care. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique Identifier: NCT03374891.
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Affiliation(s)
- Christopher E. Knoepke
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Bryan C. Wallace
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
| | - Larry A. Allen
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Carmen L. Lewis
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | | | - Pamela N. Peterson
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
- Denver Health Medical Center, Denver, CO, USA
| | - Daniel B. Kramer
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Paul D. Varosy
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
- Cardiology Section, VA Eastern Colorado Health Care System, Aurora, CO, USA
| | | | - Wendy S. Tzou
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniel D. Matlock
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA
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Petty MG, Wu T, Andrei AC, Baldridge A, Warzecha A, Kao A, Spertus J, Hsich E, Dew MA, Pham D, Yancy C, Hartupee J, Cotts W, Pamboukian SV, Pagani F, Lampert B, Johnson M, Murray M, Tekeda K, Yuzefpolskaya M, Silvestry S, Kirklin JK, Grady KL. Baseline Quality-of-Life of Caregivers of Patients With Heart Failure Prior to Advanced Therapies: Findings From the Sustaining Quality of Life of the Aged: Transplant or Mechanical Support (SUSTAIN-IT) Study. J Card Fail 2022; 28:1137-1148. [PMID: 35470057 PMCID: PMC10010287 DOI: 10.1016/j.cardfail.2022.03.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND We compared health-related quality of life (HRQOL), depressive symptoms, anxiety, and burden in caregivers of older patients with heart failure based on the intended therapy goal of the patient: awaiting heart transplantation (HT) with or without mechanical circulatory support (MCS) or prior to long-term MCS; and we identified factors associated with HRQOL. METHODS Caregivers (n = 281) recruited from 13 HT and MCS programs in the United States completed measures of HRQOL (EQ-5D-3L), depressive symptoms (PHQ-8), anxiety (STAI-state), and burden (Oberst Caregiving Burden Scale). Analyses included ANOVA, Kruskal-Wallis tests, χ2 tests, and linear regression. RESULTS The majority of caregivers were female, white spouses with ≤ 2 comorbidities, median [Q1,Q3] age = 62 [57.8, 67.0] years. Caregivers (HT with MCS = 87, HT without MCS = 98, long-term MCS = 96) reported similarly high baseline HRQOL (EQ-5D-3L visual analog scale median score = 90; P = 0.67 for all groups) and low levels of depressive symptoms. STAI-state median scores were higher in the long-term MCS group vs the HT groups with and without MCS, (38 vs 32 vs 31; P < 0.001), respectively. Burden (task: time spent/difficulty) differed significantly among groups. Caregiver factors (number of comorbidities, diabetes and higher anxiety levels) were significantly associated with worse caregiver HRQOL, R2 = 26%. CONCLUSIONS Recognizing caregiver-specific factors, including comorbidities and anxiety, associated with the HRQOL of caregivers of these older patients with advanced HF may guide support strategies.
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Affiliation(s)
- M G Petty
- From the M Health Fairview, University of Minnesota Medical Center, Minneapolis, Minnesota.
| | - T Wu
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - A C Andrei
- Division of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - A Baldridge
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - A Warzecha
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - A Kao
- Heart Failure and Transplantation Cardiology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - J Spertus
- Cardiovascular Division, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - E Hsich
- Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - M A Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania
| | - D Pham
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - C Yancy
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - J Hartupee
- Cardiovascular Division, Department of Medicine, Washington University, St. Louis, Missouri
| | - W Cotts
- Advocate Heart and Vascular Institute, Advocate Christ Medical Center, Oak Lawn, Illinois
| | - S V Pamboukian
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - F Pagani
- Division of Cardiovascular Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - B Lampert
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - M Johnson
- Department of Cardiovascular Medicine, University of Wisconsin, Madison, Wisconsin
| | - M Murray
- Department of Cardiovascular Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - K Tekeda
- Department of Surgery, Columbia University Medical Center, New York, New York
| | - M Yuzefpolskaya
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - S Silvestry
- Thoracic Transplant Programs, Florida Hospital Transplant institute, Orlando, Florida
| | - J K Kirklin
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - K L Grady
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Raymer DS, Allen LA, Chaussee EL, McIlvennan CK, Thompson JS, Fairclough DL, Dunlay SM, Matlock DD, LaRue SJ. Health Literacy in Patients Considering a Left Ventricular Assist Device: Findings from the DECIDE-LVAD Trial. J Card Fail 2022; 28:1318-1325. [DOI: 10.1016/j.cardfail.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 04/01/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
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Butler JM, Gibson B, Patterson OV, Damschroder LJ, Halls CH, Denhalter DW, Samore MH, Li H, Zhang Y, DuVall SL. Clinician documentation of patient centered care in the electronic health record. BMC Med Inform Decis Mak 2022; 22:65. [PMID: 35279157 PMCID: PMC8917709 DOI: 10.1186/s12911-022-01794-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 02/28/2022] [Indexed: 12/04/2022] Open
Abstract
Background In this study we sought to explore the possibility of using patient centered care (PCC) documentation as a measure of the delivery of PCC in a health system. Methods We first selected 6 VA medical centers based on their scores for a measure of support for self-management subscale from a national patient satisfaction survey (the Survey for Healthcare Experience-Patients). We accessed clinical notes related to either smoking cessation or weight management consults. We then annotated this dataset of notes for documentation of PCC concepts including: patient goals, provider support for goal progress, social context, shared decision making, mention of caregivers, and use of the patient's voice. We examined the association of documentation of PCC with patients’ perception of support for self-management with regression analyses. Results Two health centers had < 50 notes related to either tobacco cessation or weight management consults and were removed from further analysis. The resulting dataset includes 477 notes related to 311 patients total from 4 medical centers. For a majority of patients (201 out of 311; 64.8%) at least one PCC concept was present in their clinical notes. The most common PCC concepts documented were patient goals (patients n = 126; 63% clinical notes n = 302; 63%), patient voice (patients n = 165, 82%; clinical notes n = 323, 68%), social context (patients n = 105, 52%; clinical notes n = 181, 38%), and provider support for goal progress (patients n = 124, 62%; clinical notes n = 191, 40%). Documentation of goals for weight loss notes was greater at health centers with higher satisfaction scores compared to low. No such relationship was found for notes related to tobacco cessation. Conclusion Providers document PCC concepts in their clinical notes. In this pilot study we explored the feasibility of using this data as a means to measure the degree to which care in a health center is patient centered. Practice Implications: clinical EHR notes are a rich source of information about PCC that could potentially be used to assess PCC over time and across systems with scalable technologies such as natural language processing.
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11
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OUP accepted manuscript. Eur J Prev Cardiol 2022; 29:1124-1141. [DOI: 10.1093/eurjpc/zwac006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/25/2021] [Accepted: 01/04/2022] [Indexed: 11/12/2022]
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Jull J, Köpke S, Smith M, Carley M, Finderup J, Rahn AC, Boland L, Dunn S, Dwyer AA, Kasper J, Kienlin SM, Légaré F, Lewis KB, Lyddiatt A, Rutherford C, Zhao J, Rader T, Graham ID, Stacey D. Decision coaching for people making healthcare decisions. Cochrane Database Syst Rev 2021; 11:CD013385. [PMID: 34749427 PMCID: PMC8575556 DOI: 10.1002/14651858.cd013385.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Decision coaching is non-directive support delivered by a healthcare provider to help patients prepare to actively participate in making a health decision. 'Healthcare providers' are considered to be all people who are engaged in actions whose primary intent is to protect and improve health (e.g. nurses, doctors, pharmacists, social workers, health support workers such as peer health workers). Little is known about the effectiveness of decision coaching. OBJECTIVES To determine the effects of decision coaching (I) for people facing healthcare decisions for themselves or a family member (P) compared to (C) usual care or evidence-based intervention only, on outcomes (O) related to preparation for decision making, decisional needs and potential adverse effects. SEARCH METHODS We searched the Cochrane Library (Wiley), Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), CINAHL (Ebsco), Nursing and Allied Health Source (ProQuest), and Web of Science from database inception to June 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) where the intervention was provided to adults or children preparing to make a treatment or screening healthcare decision for themselves or a family member. Decision coaching was defined as: a) delivered individually by a healthcare provider who is trained or using a protocol; and b) providing non-directive support and preparing an adult or child to participate in a healthcare decision. Comparisons included usual care or an alternate intervention. There were no language restrictions. DATA COLLECTION AND ANALYSIS Two authors independently screened citations, assessed risk of bias, and extracted data on characteristics of the intervention(s) and outcomes. Any disagreements were resolved by discussion to reach consensus. We used the standardised mean difference (SMD) with 95% confidence intervals (CI) as the measures of treatment effect and, where possible, synthesised results using a random-effects model. If more than one study measured the same outcome using different tools, we used a random-effects model to calculate the standardised mean difference (SMD) and 95% CI. We presented outcomes in summary of findings tables and applied GRADE methods to rate the certainty of the evidence. MAIN RESULTS Out of 12,984 citations screened, we included 28 studies of decision coaching interventions alone or in combination with evidence-based information, involving 5509 adult participants (aged 18 to 85 years; 64% female, 52% white, 33% African-American/Black; 68% post-secondary education). The studies evaluated decision coaching used for a range of healthcare decisions (e.g. treatment decisions for cancer, menopause, mental illness, advancing kidney disease; screening decisions for cancer, genetic testing). Four of the 28 studies included three comparator arms. For decision coaching compared with usual care (n = 4 studies), we are uncertain if decision coaching compared with usual care improves any outcomes (i.e. preparation for decision making, decision self-confidence, knowledge, decision regret, anxiety) as the certainty of the evidence was very low. For decision coaching compared with evidence-based information only (n = 4 studies), there is low certainty-evidence that participants exposed to decision coaching may have little or no change in knowledge (SMD -0.23, 95% CI: -0.50 to 0.04; 3 studies, 406 participants). There is low certainty-evidence that participants exposed to decision coaching may have little or no change in anxiety, compared with evidence-based information. We are uncertain if decision coaching compared with evidence-based information improves other outcomes (i.e. decision self-confidence, feeling uninformed) as the certainty of the evidence was very low. For decision coaching plus evidence-based information compared with usual care (n = 17 studies), there is low certainty-evidence that participants may have improved knowledge (SMD 9.3, 95% CI: 6.6 to 12.1; 5 studies, 1073 participants). We are uncertain if decision coaching plus evidence-based information compared with usual care improves other outcomes (i.e. preparation for decision making, decision self-confidence, feeling uninformed, unclear values, feeling unsupported, decision regret, anxiety) as the certainty of the evidence was very low. For decision coaching plus evidence-based information compared with evidence-based information only (n = 7 studies), we are uncertain if decision coaching plus evidence-based information compared with evidence-based information only improves any outcomes (i.e. feeling uninformed, unclear values, feeling unsupported, knowledge, anxiety) as the certainty of the evidence was very low. AUTHORS' CONCLUSIONS Decision coaching may improve participants' knowledge when used with evidence-based information. Our findings do not indicate any significant adverse effects (e.g. decision regret, anxiety) with the use of decision coaching. It is not possible to establish strong conclusions for other outcomes. It is unclear if decision coaching always needs to be paired with evidence-informed information. Further research is needed to establish the effectiveness of decision coaching for a broader range of outcomes.
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Affiliation(s)
- Janet Jull
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Sascha Köpke
- Institute of Nursing Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Meg Carley
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Research Centre for Patient Involvement, Aarhus University & the Central Denmark Region, Aarhus, Denmark
| | - Anne C Rahn
- Institute of Social Medicine and Epidemiology, Nursing Research Unit, University of Lubeck, Lubeck, Germany
| | - Laura Boland
- Integrated Knowledge Translation Research Network, The Ottawa Hospital Research Institute, Ottawa, Canada
- Western University, London, Canada
| | - Sandra Dunn
- BORN Ontario, CHEO Research Institute, School of Nursing, University of Ottawa, Ottawa, Canada
| | - Andrew A Dwyer
- William F. Connell School of Nursing, Boston University, Chestnut Hill, Massachusetts, USA
- Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jürgen Kasper
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Simone Maria Kienlin
- Faculty of Health Sciences, Department of Health and Caring Sciences, University of Tromsø, Tromsø, Norway
- The South-Eastern Norway Regional Health Authority, Department of Medicine and Healthcare, Hamar, Norway
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Canada
| | - Krystina B Lewis
- School of Nursing, University of Ottawa, Ottawa, Canada
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, Canada
| | | | - Claudia Rutherford
- School of Psychology, Quality of Life Office, University of Sydney, Camperdown, Australia
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Junqiang Zhao
- School of Nursing, University of Ottawa, Ottawa, Canada
| | - Tamara Rader
- Canadian Agency for Drugs and Technologies in Health (CADTH), Ottawa, Canada
| | - Ian D Graham
- Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Canada
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McIlvennan CK, Jones J, Makic M, Meek PM, Chaussee E, Thompson JS, Matlock DD, Allen LA. Stress and Coping Among Family Caregivers of Patients With a Destination Therapy Left Ventricular Assist Device: A Multicenter Mixed Methods Study. Circ Heart Fail 2021; 14:e008243. [PMID: 34465131 PMCID: PMC8559583 DOI: 10.1161/circheartfailure.120.008243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Family caregivers of patients with a destination therapy left ventricular assist device play a central and formalized role in postimplant care. We aimed to characterize longitudinal stress, predictors and correlates of stress, and coping processes among left ventricular assist device caregivers. METHODS We performed a sequential, exploratory, mixed-methods study from 6 diverse left ventricular assist device programs. The primary outcome for the quantitative analysis was the Perceived Stress Scale-10 at 6 months (0-40). Based on the quantitative findings and guided by the Transactional Model of Stress and Coping, semistructured interviews explored causes of stress and coping processes. Integration was performed during the qualitative and interpretation phase. RESULTS A total of 96 caregivers met inclusion criteria for quantitative analysis. Mean (SD) Perceived Stress Scale score was 14.3 (5.5) preimplant and 11.8 (6.9) at 6 months. Preimplant, only decreased preparedness for caregiving was associated with higher Perceived Stress Scale score at 6 months. At 6 months, increased caregiver depressive symptoms, decreased caregiver preparedness for caregiving, and lower patient quality of life were associated with higher Perceived Stress Scale score. Qualitative analysis of 25 caregivers revealed the causes of stress coalesced around 3 themes: (1) lack of preparedness to be a caregiver, (2) uniqueness of stress for the caregiver and patient situation, and (3) caregiving responsibilities physically and emotionally impacting caregivers. To cope with stress, most caregivers employed emotion-focused coping. CONCLUSIONS In family caregivers of patients with a left ventricular assist device, higher perceived stress was associated with lower caregiver preparedness, higher caregiver depressive symptoms, and lower patient quality of life. Emotion-focused coping strategies were common for caregivers. Future work should better prepare caregivers for this role and support them through the caregiving experience. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02344576.
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Affiliation(s)
- Colleen K McIlvennan
- Section of Advanced Heart Failure and Transplantation, Division of Cardiology (C.K.M., L.A.A.), University of Colorado School of Medicine, Aurora.,Adult and Child Consortium for Health Outcomes Research and Delivery Science (C.K.M., E.C., J.S.T., D.D.M., L.A.A.), University of Colorado School of Medicine, Aurora
| | - Jacqueline Jones
- University of Colorado College of Nursing, Aurora (J.J., M.M., P.M.M.)
| | - Marybeth Makic
- University of Colorado College of Nursing, Aurora (J.J., M.M., P.M.M.)
| | - Paula M Meek
- University of Colorado College of Nursing, Aurora (J.J., M.M., P.M.M.)
| | - Erin Chaussee
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (C.K.M., E.C., J.S.T., D.D.M., L.A.A.), University of Colorado School of Medicine, Aurora
| | - Jocelyn S Thompson
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (C.K.M., E.C., J.S.T., D.D.M., L.A.A.), University of Colorado School of Medicine, Aurora
| | - Daniel D Matlock
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (C.K.M., E.C., J.S.T., D.D.M., L.A.A.), University of Colorado School of Medicine, Aurora.,Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Denver (D.D.M.)
| | - Larry A Allen
- Section of Advanced Heart Failure and Transplantation, Division of Cardiology (C.K.M., L.A.A.), University of Colorado School of Medicine, Aurora.,Adult and Child Consortium for Health Outcomes Research and Delivery Science (C.K.M., E.C., J.S.T., D.D.M., L.A.A.), University of Colorado School of Medicine, Aurora
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Gilotra NA, Pamboukian SV, Mountis M, Robinson SW, Kittleson M, Shah KB, Forde-McLean RC, Haas DC, Horstmanshof DA, Jorde UP, Russell SD, Taddei-Peters WC, Jeffries N, Khalatbari S, Spino CA, Richards B, Yosef M, Mann DL, Stewart GC, Aaronson KD, Grady KL. Caregiver Health-Related Quality of Life, Burden, and Patient Outcomes in Ambulatory Advanced Heart Failure: A Report From REVIVAL. J Am Heart Assoc 2021; 10:e019901. [PMID: 34250813 PMCID: PMC8483456 DOI: 10.1161/jaha.120.019901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Heart failure (HF) imposes significant burden on patients and caregivers. Longitudinal data on caregiver health-related quality of life (HRQOL) and burden in ambulatory advanced HF are limited. Methods and Results Ambulatory patients with advanced HF (n=400) and their participating caregivers (n=95) enrolled in REVIVAL (Registry Evaluation of Vital Information for VADs [Ventricular Assist Devices] in Ambulatory Life) were followed up for 24 months, or until patient death, left ventricular assist device implantation, heart transplantation, or loss to follow-up. Caregiver HRQOL (EuroQol Visual Analog Scale) and burden (Oberst Caregiving Burden Scale) did not change significantly from baseline to follow-up. At time of caregiver enrollment, better patient HRQOL by Kansas City Cardiomyopathy Questionnaire was associated with better caregiver HRQOL (P=0.007) and less burden by both time spent (P<0.0001) and difficulty (P=0.0007) of caregiving tasks. On longitudinal analyses adjusted for baseline values, better patient HRQOL (P=0.034) and being a married caregiver (P=0.016) were independently associated with better caregiver HRQOL. Patients with participating caregivers (versus without) were more likely to prefer left ventricular assist device therapy over time (odds ratio, 1.43; 95% CI, 1.03-1.99; P=0.034). Among patients with participating caregivers, those with nonmarried (versus married) caregivers were at higher composite risk of HF hospitalization, death, heart transplantation or left ventricular assist device implantation (hazard ratio, 2.99; 95% CI, 1.29-6.96; P=0.011). Conclusions Patient and caregiver characteristics may impact their HRQOL and other health outcomes over time. Understanding the patient-caregiver relationship may better inform medical decision making and outcomes in ambulatory advanced HF.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Wendy C Taddei-Peters
- Division of Cardiovascular Sciences National Heart, Lung, and Blood Institute Bethesda MD
| | - Neal Jeffries
- Division of Cardiovascular Sciences National Heart, Lung, and Blood Institute Bethesda MD
| | - Shokoufeh Khalatbari
- University of MichiganMichigan Institute for Clinical and Health Research Ann Arbor MI
| | | | - Blair Richards
- University of MichiganMichigan Institute for Clinical and Health Research Ann Arbor MI
| | - Matheos Yosef
- University of MichiganMichigan Institute for Clinical and Health Research Ann Arbor MI
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Martin RW, Brogård Andersen S, O'Brien MA, Bravo P, Hoffmann T, Olling K, Shepherd HL, Dankl K, Stacey D, Dahl Steffensen K. Providing Balanced Information about Options in Patient Decision Aids: An Update from the International Patient Decision Aid Standards. Med Decis Making 2021; 41:780-800. [PMID: 34196241 DOI: 10.1177/0272989x211021397] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The objective of this International Patient Decision Aids Standard (IPDAS) review is to update and synthesize theoretical and empirical evidence on how balanced information can be presented and measured in patient decision aids (PtDAs). METHODS A multidisciplinary team conducted a scoping review using 2 search strategies in multiple electronic databases evaluating the ways investigators defined and measured the balance of information provided about options in PtDAs. The first strategy combined a search informed by the Cochrane Review of the Effectiveness of Decision Aids with a search on balanced information. The second strategy repeated the search published in the 2013 IPDAS update on balanced presentation. RESULTS Of 2450 unique citations reviewed, the full text of 168 articles was screened for eligibility. Sixty-four articles were included in the review, of which 13 provided definitions of balanced presentation, 8 evaluated mechanisms that may introduce bias, and 42 quantitatively measured balanced with methods consistent with the IPDAS criteria in PtDAs. The revised definition of balanced information is, "Objective, complete, salient, transparent, evidence-informed, and unbiased presentation of text and visual information about the condition and all relevant options (with important elements including the features, benefits, harms and procedures of those options) in a way that does not favor one option over another and enables individuals to focus attention on important elements and process this information." CONCLUSIONS Developers can increase the balance of information in PtDAs by informing their structure and design elements using the IPDAS checklist. We suggest that new PtDA components pertaining to balance be evaluated for cognitive bias with experimental methods as well by objectively evaluating patients' and content experts' beliefs from multiple perspectives.
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Affiliation(s)
- Richard W Martin
- Michigan State University, College of Human Medicine, Grand Rapids, MI, USA
| | - Stina Brogård Andersen
- Department of Clinical Development, Odense University Hospital, Odense, Denmark.,Center for Shared Decision Making, Lillebaelt Hospital-University Hospital of Southern Denmark, Vejle, Denmark.,Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Mary Ann O'Brien
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Paulina Bravo
- School of Nursing, Pontificia Universidad Católica de Chile, Santiago, Chile.,Millennium Nucleus Center Authority and Power Asymmetries
| | - Tammy Hoffmann
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Karina Olling
- Center for Shared Decision Making, Lillebaelt Hospital-University Hospital of Southern Denmark, Vejle, Denmark
| | - Heather L Shepherd
- University of Sydney, Faculty of Science, Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, Sydney, Australia
| | - Kathrina Dankl
- Design School Kolding, Lab for Social Design, Kolding, Denmark
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Clinical Epidemiology Program.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Karina Dahl Steffensen
- Center for Shared Decision Making, Lillebaelt Hospital-University Hospital of Southern Denmark, Vejle, Denmark.,Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Clinical Oncology, Lillebaelt Hospital-University Hospital of Southern Denmark, Vejle, Denmark
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Matlock DD, McIlvennan CK, Thompson JS, Morris MA, Venechuk G, Dunlay SM, LaRue SJ, Lewis EF, Patel CB, Blue L, Chaussee EL, Glasgow RE, Walsh MN, Allen LA. Decision Aid Implementation among Left Ventricular Assist Device Programs Participating in the DECIDE-LVAD Stepped-Wedge Trial. Med Decis Making 2021; 40:289-301. [PMID: 32428430 DOI: 10.1177/0272989x20915227] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background. Despite demonstrated efficacy, patient decision aids (DAs) are rarely used in clinical practice in the absence of coverage mandates. Deciding whether to pursue a left ventricular assist device (LVAD) is a major, preference-sensitive decision-ideal for exploring implementation of a DA. Methods. We conducted a type II effectiveness-implementation hybrid trial at 6 LVAD programs using a stepped-wedge cluster-randomized design. Using the RE-AIM framework, we collected both quantitative and qualitative outcomes, including a checklist collected by study staff for each enrolled patient regarding DA use and interviews with LVAD program clinicians preintervention, 6 months postintervention, and at the conclusion of the study. Results. From June 2015 to January 2017, 248 patients and their caregivers were enrolled. A total of 69 interviews were conducted with 48 clinicians at 3 time points. The DA reached 95% of eligible patients. Adoption was 100%, as all sites approached agreed to participate in the trial. Interviews revealed several themes related to the implementation of the DA: clinicians had a strong desire to ensure patients were informed and embraced the DA. Despite this, they reported communication challenges among their team that impeded implementation. Five of the 6 sites have maintained use of the DA following the trial; 1 site reported concerns about decreased procedural volume with use of the DA as a reason for discontinuation. Conclusions. In this hybrid trial, a DA for patients considering LVADs and their caregivers demonstrated high reach. Adoption and implementation were facilitated by a strong desire to ensure that patients were well informed. Future dissemination research and practice should attend to concerns about procedure volume and coverage mandates and facilitate ongoing communication at sites using the DA.
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Affiliation(s)
- Daniel D Matlock
- Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA.,Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
| | - Colleen K McIlvennan
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jocelyn S Thompson
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
| | - Megan A Morris
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
| | - Grace Venechuk
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
| | - Shannon M Dunlay
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Shane J LaRue
- Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Laura Blue
- Duke University Medical Center, Durham, NC, USA
| | - Erin L Chaussee
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
| | - Russell E Glasgow
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
| | - Mary Norine Walsh
- St. Vincent Heart Center, Division of Cardiology, Indianapolis, IN, USA
| | - Larry A Allen
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA.,Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
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Thompson JS, Fitzgerald MD, Allen LA, McIlvennan CK, Glasgow RE, Wynia M, Morris MA, Beilenson J, Gherst C, Matlock DD. Shared Decision-Making for Left Ventricular Assist Devices: Rationale and Design of a Nationwide Dissemination and Implementation Project. Circ Cardiovasc Qual Outcomes 2021; 14:e007256. [PMID: 33530698 PMCID: PMC7887063 DOI: 10.1161/circoutcomes.120.007256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background The left ventricular assist device (LVAD) has become a common medical option for patients with end-stage heart failure. Although patients' chances of survival may increase with an LVAD compared with medical therapy, the LVAD poses many risks and requires major lifestyle changes, thus making it a complex medical decision. Our prior work found that a decision aid for LVADs significantly increased decision quality for both patients and caregivers and was successfully implemented at 6 LVAD programs. Methods In follow-up, we are conducting a nationwide dissemination and implementation project, with the goal of implementing the decision aid at as many of the 176 LVAD programs in the United States as possible. Guided by the Theory of Diffusion of Innovations, the project consists of 4 phases: (1) building a network; (2) promoting adoption; (3) supporting implementation; and (4) encouraging maintenance. Developing an LVAD network of contacts occurs by using a national baseline survey of LVAD clinicians, existing professional relationships, and an internet-based strategy. A suite of resources targeted to promote adoption and support implementation of the decision aid into standard LVAD education processes are provided to the network. Evaluation is guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance framework, where clinician and patient surveys and qualitative interviews determine the reach, effectiveness, adoption, implementation, and maintenance achieved. Conclusions This project is a true dissemination study in that it targets the entire population of LVAD programs in the United States and is unique in its use of social marketing principles to promote adoption and implementation. The implementation plan is intended to serve as a test case and model for dissemination and implementation of other evidence-based decision support aids and strategies.
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Affiliation(s)
- Jocelyn S. Thompson
- Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO
| | - Monica D. Fitzgerald
- Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO
| | - Larry A. Allen
- Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO
| | - Colleen K. McIlvennan
- Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO
| | - Russell E. Glasgow
- Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO
| | - Matthew Wynia
- Center for Bioethics and Humanities, University of Colorado School of Medicine, Aurora, CO
| | - Megan A. Morris
- Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO
| | | | - Chris Gherst
- Strategic Communications and Planning, Inc., Wayne, PA
| | - Dan D. Matlock
- Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO
- Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, CO
- Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO
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18
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Cruz-Oliver DM, Pacheco Rueda A, Viera-Ortiz L, Washington KT, Oliver DP. The evidence supporting educational videos for patients and caregivers receiving hospice and palliative care: A systematic review. PATIENT EDUCATION AND COUNSELING 2020; 103:1677-1691. [PMID: 32241583 PMCID: PMC7495206 DOI: 10.1016/j.pec.2020.03.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The purpose of this study is to explore the evidence surrounding educational videos for patients and family caregivers in hospice and palliative care. We ask three research questions: 1. What is the evidence for video interventions? 2. What is the quality of the evidence behind video interventions? 3. What are the outcomes of video interventions? METHODS The study is a systematic review, following Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Researchers systematically searched five databases for experimental and observational studies on the evidence supporting video education for hospice and palliative care patients and caregivers, published in 1969-2019. RESULTS The review identified 31 relevant articles with moderate-high quality of evidence. Most studies were experimental (74 %), came from the United States (84 %) and had a mean sample size of 139 participants. Studies showed that video interventions positively affect preferences of care and advance care planning, provide emotional support, and serve as decision and information aids. CONCLUSION A strong body of evidence has emerged for video education interventions in hospice and palliative care. Additional research assessing video interventions' impact on clinical outcomes is needed. PRACTICE IMPLICATIONS Videos are a promising tool for patient and family education in hospice and palliative care.
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Affiliation(s)
- Dulce M Cruz-Oliver
- Palliative Medicine Program, Johns Hopkins Hospital, 600 N. Wolfe Street, Suite 342B, Baltimore, MD, 21287, USA.
| | - Angel Pacheco Rueda
- University of Puerto Rico, Medical Sciences Campus, School of Medicine, Box 365067, San Juan, 00936-5067, Puerto Rico.
| | - Liliana Viera-Ortiz
- University of Puerto Rico, Medical Sciences Campus, Department of Surgery, Box 365067, San Juan, 00936-5067, Puerto Rico.
| | - Karla T Washington
- Department of Family and Community Medicine, University of Missouri Medical Sciences Building, DC032.00, Columbia, MO, 65212, USA.
| | - Debra Parker Oliver
- Department of Family and Community Medicine, University of Missouri Medical Sciences Building, DC032.00, Columbia, MO, 65212, USA.
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19
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Streur MM, Auld JP, Liberato ACS, Beckman JA, Mahr C, Thompson EA, Dougherty CM. Left Ventricular Assist Device Caregiver Experiences and Health Outcomes: A Systematic Review of Qualitative and Quantitative Studies. J Card Fail 2020; 26:713-726. [PMID: 32505816 DOI: 10.1016/j.cardfail.2020.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Knowledge synthesis is lacking regarding outcomes and experiences of caregivers of adult patients living with continuous flow left ventricular assist devices (CF-LVAD). The purpose of this systematic review was to summarize qualitative data related to the experience of caregivers of adult patients living with CF-LVAD as well as quantitative data related to health outcomes of caregivers. METHODS AND RESULTS Multiple databases were systematically queried for studies of qualitative experiences and quantitative health outcomes for caregivers of adult CF-LVAD recipients. Search dates were constrained to articles published between 2004 and August of 2018 because CF-LVADs were not routinely implanted before 2004. Two authors independently screened 683 articles; 15 met predetermined inclusion criteria. Eligible articles reported results from 13 studies. Of those, 8 used either qualitative or mixed methods and 5 used quantitative methods. Caregivers were primarily female (81%) and their mean age was 59 years. Qualitative studies revealed 3 overarching themes related to the caregiver role, coping strategies, and LVAD decisions. Quantitative studies revealed caregiver strain peaked between 1 and 3 months after implantation, anxiety and depression were relatively stable, mental health status improved, and physical health status was stable from before to after implantation. CONCLUSIONS CF-LVAD caregivers experience significant, sustained emotional strain for 3 months after implantation, reporting considerable stress in meeting their personal needs and those of their loved one.
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Affiliation(s)
- Megan M Streur
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington.
| | - Jonathan P Auld
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington
| | - Ana Carolina Sauer Liberato
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington
| | - Jennifer A Beckman
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington
| | - Claudius Mahr
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington
| | - Elaine A Thompson
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington
| | - Cynthia M Dougherty
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington
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20
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Kitko L, McIlvennan CK, Bidwell JT, Dionne-Odom JN, Dunlay SM, Lewis LM, Meadows G, Sattler EL, Schulz R, Strömberg A. Family Caregiving for Individuals With Heart Failure: A Scientific Statement From the American Heart Association. Circulation 2020; 141:e864-e878. [DOI: 10.1161/cir.0000000000000768] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Many individuals living with heart failure (HF) rely on unpaid support from their partners, family members, friends, or neighbors as caregivers to help manage their chronic disease. Given the advancements in treatments and devices for patients with HF, caregiving responsibilities have expanded in recent decades to include more intensive care for increasingly precarious patients with HF—tasks that would previously have been undertaken by healthcare professionals in clinical settings. The specific tasks of caregivers of patients with HF vary widely based on the patient’s symptoms and comorbidities, the relationship between patient and caregiver, and the complexity of the treatment regimen. Effects of caregiving on the caregiver and patient range from physical and psychological to financial. Therefore, it is critically important to understand the needs of caregivers to support the increasingly complex medical care they provide to patients living with HF. This scientific statement synthesizes the evidence pertaining to caregiving of adult individuals with HF in order to (1) characterize the HF caregiving role and how it changes with illness trajectory; (2) describe the financial, health, and well-being implications of caregiving in HF; (3) evaluate HF caregiving interventions to support caregiver and patient outcomes; (4) summarize existing policies and resources that support HF caregivers; and (5) identify knowledge gaps and future directions for providers, investigators, health systems, and policymakers.
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21
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Fendler TJ, McIlvennan CK, Matlock DD, Thompson JS, Chaussee EL, Dunlay SM, LaRue SJ, Raymer DS, Spertus JA, Lewis EF, Patel CB, Walsh MN, Allen LA. Exploring differences between patients who accept, decline, and are deemed ineligible for left ventricular assist device implantation as destination therapy. J Heart Lung Transplant 2020; 39:721-724. [PMID: 32376277 DOI: 10.1016/j.healun.2020.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/10/2020] [Accepted: 03/27/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- Timothy J Fendler
- Health Outcomes Research, University of Missouri-Kansas City, Kansas City, Missouri; Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
| | - Colleen K McIlvennan
- Adult and Child Consortium for Outcomes Research and Delivery Science; Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel D Matlock
- Adult and Child Consortium for Outcomes Research and Delivery Science; Veterans Affairs, Eastern Colorado Geriatric Research Education and Clinical Center, Denver, Colorado; Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Erin L Chaussee
- Adult and Child Consortium for Outcomes Research and Delivery Science; Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, Colorado
| | - Shannon M Dunlay
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Shane J LaRue
- Department of Internal Medicine, Cardiovascular Division, Washington University School of Medicine, St Louis, Missouri
| | - David S Raymer
- Adult and Child Consortium for Outcomes Research and Delivery Science
| | - John A Spertus
- Health Outcomes Research, University of Missouri-Kansas City, Kansas City, Missouri; Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | | | - Chetan B Patel
- Department of Medicine, Cardiology Division, Duke University Medical Center, Durham, North Carolina
| | - Mary Norine Walsh
- Division of Cardiology, St Vincent Heart Center, Indianapolis, Indiana
| | - Larry A Allen
- Adult and Child Consortium for Outcomes Research and Delivery Science; Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
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22
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Coylewright M, Keevil JG, Xu K, Dodge SE, Frosch D, Field ME. Pragmatic Study of Clinician Use of a Personalized Patient Decision Aid Integrated into the Electronic Health Record: An 8-Year Experience. Telemed J E Health 2020; 26:597-602. [DOI: 10.1089/tmj.2019.0112] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Megan Coylewright
- Section of Cardiovascular Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- The Dartmouth Institute for Clinical Practice and Health Policy, Lebanon, New Hampshire, USA
| | - Jon G. Keevil
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Keren Xu
- Section of Cardiovascular Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Shayne E. Dodge
- Section of Cardiovascular Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Dominick Frosch
- Palo Alto Medical Foundation Research Institute, Palo Alto, California, USA
| | - Michael E. Field
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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23
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McIlvennan CK, Matlock DD, Allen LA, Thompson JS, Ranby KW, Sannes TS. Perceived Stress and Depressive Symptoms as Predictors of Decisional Conflict in Dyads Considering a Left Ventricular Assist Device. Circ Cardiovasc Qual Outcomes 2020; 13:e006155. [PMID: 32148099 DOI: 10.1161/circoutcomes.119.006155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The decision to pursue a left ventricular assist device (LVAD) commits loved ones to major caregiving responsibilities and, often, medical decision-making. How emotional domains overlap within patients and their caregivers and contribute to conflict around the decision to pursue LVAD remains largely unexplored. METHODS AND RESULTS The associations within and between individuals in patient-caregiver dyads considering LVAD were estimated in a specific type of structural equation model known as the Actor-Partner Interdependence Model. This model tested whether each person's depression and stress predicted their own decisional conflict (actor effects), as well as their partner's decisional conflict (partner effects). At the time of study enrollment when a formal LVAD evaluation was initiated, 162 patient-caregiver dyads completed assessments of decisional conflict using the Decisional Conflict Scale, depressive symptoms using the Patient Health Questionnaire-2, and stress using the Perceived Stress Scale. Across both models, decisional conflict was significantly correlated within patient-caregiver dyads (β=0.47 and 0.44, for depression and perceived stress models, respectively, P<0.001). Greater perceived stress in both the patient (β=0.18; P<0.05) and caregiver (β=0.28; P<0.001) was significantly related to greater decisional conflict (both actor effects). Greater patient depressive symptoms were related to greater patient decisional conflict (β=0.16; P<0.05), whereas caregiver depression symptoms was not related to their own decisional conflict (β=0.07; P=0.37). There were no partner effects identified between decisional conflict and perceived stress or depressive symptoms. CONCLUSIONS Patient and caregiver conflict over the decision to pursue an LVAD was highly correlated in this sample, with greater perceived stress significantly predicting greater decisional conflict in both patients and caregivers. Depressive symptoms in patients also predicted greater patient decisional conflict. No partner effects were identified in predicting decisional conflict. These results contribute to a larger body of work acknowledging the importance of patient-caregiver well-being in serious illness. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02344576.
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Affiliation(s)
- Colleen K McIlvennan
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (C.K.M., D.D.M., L.A.A., J.S.T.), University of Colorado School of Medicine, Aurora, CO.,Division of Cardiology (C.K.M., L.A.A.), University of Colorado School of Medicine, Aurora, CO
| | - Daniel D Matlock
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (C.K.M., D.D.M., L.A.A., J.S.T.), University of Colorado School of Medicine, Aurora, CO.,Veteran Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO (D.D.M.)
| | - Larry A Allen
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (C.K.M., D.D.M., L.A.A., J.S.T.), University of Colorado School of Medicine, Aurora, CO.,Division of Cardiology (C.K.M., L.A.A.), University of Colorado School of Medicine, Aurora, CO
| | - Jocelyn S Thompson
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (C.K.M., D.D.M., L.A.A., J.S.T.), University of Colorado School of Medicine, Aurora, CO
| | - Krista W Ranby
- Department of Psychology, University of Colorado Denver (K.W.R.)
| | - Timothy S Sannes
- Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA (T.S.S.)
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24
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McIlvennan CK, Benton EM, Allen LA. Educate, Engage, Empower: Leveraging Technology to Promote Learning in Patients Implanted With a Left Ventricular Assist Device and Their Caregivers. Circ Cardiovasc Qual Outcomes 2019; 12:e006107. [PMID: 31601112 DOI: 10.1161/circoutcomes.119.006107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Colleen K McIlvennan
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (C.K.M., L.A.A.), University of Colorado School of Medicine, Aurora.,Division of Cardiology (C.K.M., E.M.B., L.A.A.), University of Colorado School of Medicine, Aurora
| | - Emily M Benton
- Division of Cardiology (C.K.M., E.M.B., L.A.A.), University of Colorado School of Medicine, Aurora
| | - Larry A Allen
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (C.K.M., L.A.A.), University of Colorado School of Medicine, Aurora.,Division of Cardiology (C.K.M., E.M.B., L.A.A.), University of Colorado School of Medicine, Aurora
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25
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DeFilippis EM, Nakagawa S, Maurer MS, Topkara VK. Left Ventricular Assist Device Therapy in Older Adults: Addressing Common Clinical Questions. J Am Geriatr Soc 2019; 67:2410-2419. [DOI: 10.1111/jgs.16105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Ersilia M. DeFilippis
- Division of Cardiology, Department of Medicine Columbia University College of Physicians and Surgeons New York New York
| | - Shunichi Nakagawa
- Adult Palliative Care, Department of Medicine Columbia University College of Physicians and Surgeons New York New York
| | - Mathew S. Maurer
- Division of Cardiology, Department of Medicine Columbia University College of Physicians and Surgeons New York New York
| | - Veli K. Topkara
- Division of Cardiology, Department of Medicine Columbia University College of Physicians and Surgeons New York New York
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26
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Birriel B, Alonso W, Kitko LA, Hupcey JE. Family caregiver-reported outcomes regarding decision-making for left ventricular assist device implantation. Heart Lung 2019; 48:308-312. [PMID: 30981423 DOI: 10.1016/j.hrtlng.2019.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/05/2019] [Accepted: 03/12/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Family caregivers (FCGs) often participate in the decision for their loved one to receive a left ventricular assist device (LVAD). Little is known about the contribution of FCGs to this complex decision. OBJECTIVES To investigate family caregiver-reported outcomes related to decision-making for LVAD implantation and their experiences post-implantation. METHODS Descriptive thematic analysis was used to analyze longitudinal data. Thematic saturation was achieved. RESULTS Three key themes emerged from the data. The main theme in the pre-implantation period was: Not a decision. The two themes in the post-implantation period were: More satisfaction than regret and Unanticipated situational change. CONCLUSIONS Family caregiver-reported outcomes inform clinical practice and future research. FCGs of LVAD recipients did not see viable alternatives to LVAD implantation, were generally satisfied with post-implantation outcomes, and experienced unexpected life changes in the post-implantation period despite feeling prepared preoperatively. Education of both LVAD recipients and their FCGs must be optimized.
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Affiliation(s)
- Barbara Birriel
- The Pennsylvania State University, College of Nursing, 90 Hope Drive, 1300 Academic Support Building / A110, Hershey, PA 17033, United States.
| | - Windy Alonso
- The Pennsylvania State University, College of Nursing, 90 Hope Drive, 1300 Academic Support Building / A110, Hershey, PA 17033, United States; University of Nebraska Medical Center, College of Nursing, 985330 Nebraska Medical Center, Omaha, NE 68198-5330, United States
| | - Lisa A Kitko
- The Pennsylvania State University, College of Nursing, 90 Hope Drive, 1300 Academic Support Building / A110, Hershey, PA 17033, United States; The Pennsylvania State University, College of Nursing, 307H Nursing Sciences Building, University Park, PA 16802, United States
| | - Judith E Hupcey
- The Pennsylvania State University, College of Nursing, 90 Hope Drive, 1300 Academic Support Building / A110, Hershey, PA 17033, United States
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27
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McIlvennan CK, Matlock DD. "Have You Ever Seen That Movie Misery…" Time to Think Outside the Box to Help Caregivers of Patients With Left Ventricular Assist Devices. Circ Cardiovasc Qual Outcomes 2019; 12:e005454. [PMID: 30636481 DOI: 10.1161/circoutcomes.118.005454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Colleen K McIlvennan
- Division of Cardiology (C.K.M.), Department of Medicine, University of Colorado School of Medicine, Aurora
| | - Daniel D Matlock
- Division of Geriatric Medicine (D.D.M.), Department of Medicine, University of Colorado School of Medicine, Aurora.,VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO (D.D.M.).,Adult and Child Consortium for Outcomes Research and Delivery Science (D.D.M.)
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