Living with a left ventricular assist device: Capturing recipients experiences using group concept mapping software

Background

Left ventricular assist device (LVAD) implantation significantly impacts on a recipient’s symptoms and quality of life. Capturing their experiences and post implant journey is an important part of clinical practice, research and device design evolution. Patient reported outcome measures (PROMs) are a useful tool for capturing that experience. However, patient reported outcome measures need to reflect recipients’ experiences. Discussions with a patient partner group found that none of the frequently used cardiology PROMs captured their unique experiences.

Aims

To capture the experiences and important issues for LVAD recipients. Develop a conceptual map of domains and items that should be reflected in patient reported outcomes.

Methods

Group concept mapping (GCM) web-based software was used to remotely capture and structure recipients’ experiences across a wide geographical area. GCM is a semi-quantitative mixed method consisting of 3 stages: item generation, item sorting and rating (importance, relevance and frequency). Patient partners were involved in all aspects of the study design and development.

Results

18 LVAD recipients consented to take part. 101 statements were generated and multi-dimensional scaling, and hierarchical cluster analysis identified 9 clusters. Cluster themes included: Activities, Partner/family support, Travel, Mental wellbeing, Equipment and clothing, Physical and cognitive limitations, LVAD Restrictions, LVAD Challenges and positive impact of the LVAD (LVAD Positives). LVAD Positives were scored highest across all the rating variables, e.g., frequency (2.85), relevance (2.44) and importance (2.21). Other domains rated high for importance included physical and cognitive limitations (2.19), LVAD restrictions (2.11), Partner/family support (2.02), and Equipment and clothing (2.01).

Conclusion

Online GCM software facilitated the inclusion of geographically dispersed recipients and provided useful insights into the experiences of LVAD recipients. The conceptual framework identifies important domains and items that should be prioritised and included in patient reported outcomes in future research, LVAD design evolution, and clinical practice.

Using group concept mapping software to develop a conceptual framework of left ventricular assist device recipients' experiences

Background

Advanced Heart failure (AHF) carries a high mortality rate. Heart transplantation is one therapeutic option, but low donation rates limits its availability. A left ventricular assist device (LVAD) is an alternative therapy which helps relieve symptoms, while improving prognosis and quality of life. However, lack of donors also means that the LVAD becomes a destination therapy by default.(1) Living with an LVAD requires significant psychological, social and physical adaptation for the recipients' and their families.(2) Patient reported outcome measures (PROMs) are one way of capturing these concerns and ongoing problems. Discussions with a patient and public involvement group found a range of issues not currently captured by available PROMS.

Aim

To develop a conceptual framework which reflects the experiences of LVAD recipients' and evaluate their importance for inclusion in PROMs using a research web platform.

Method

Participants were recruited from a regional transplant centre which covers a wide geographical area in the UK. Ethical approval was obtained and participants were recruited through routine LVAD clinics. Group concept mapping (GCM) is a semi-quantitative mixed methods approach that can be used to capture and quantify recipients' experiences.(3) Groupwisdom concept mapping software was used as the electronic data collection platform.(4) GCM consists of 3 stages: statement generation, thematic statement sorting, and rating statements for importance, relevance and frequency of impact. Multidimensional scaling and hierarchical cluster analysis produces visual representations of recipients' experiences as a points and cluster map, and scoring of statements produces relative importance of items across the clusters.

Results

18 LVAD recipients consented to take part. 101 items and 9 clusters were generated. Clusters represented: Activities; Partner/family dependency; Travel; Mental well-being; LVAD challenges; Equipment and clothing; Physical and cognitive limitations; Restrictions, and LVAD positives. LVAD Positives and LVAD restrictions were rated high for frequency, relevance and importance. Physical and cognitive limitations was rated high for importance and frequency. Equipment was rated high for relevance and frequency, and Challenges was rated high for relevance.

Conclusion

GCM and the online software is a useful tool for developing a conceptual framework and mapping key areas of importance for LVAD recipients, especially, when prioritising important patient reported outcome domains for use in clinical practice, future research and design evolution. Using an electronic platform allowed us to reach participants dispersed over a wide geographical area.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): British Heart FoundationNational Institute for Health Research Cluster Rating Map for Importance

Algorithms to guide ambulance clinicians in the management of emergencies in patients with implanted rotary left ventricular assist devices

Advances in left ventricular assist device (LVAD) therapy have resulted in increasing numbers of adult LVAD recipients in the community. However, device failure, stroke, bleeding, LVAD thrombosis and systemic infection can be life-threatening emergencies. Currently, four LVAD systems are implanted in six UK transplant centres, each of which provides device-specific information to local emergency services. This has resulted in inconsistent availability and content of information with the risks of delayed or inappropriate decision-making. In order to improve patient safety, a consortium of UK healthcare professionals with expertise in LVADs developed universally applicable prehospital emergency algorithms. Guidance was framed as closely as possible on the standard ABCDE approach to the assessment of critically ill patients.

Development and testing of a theory-based behavioural change intervention: a pilot investigation in a nursery school in a deprived area of Scotland

OBJECTIVE

Investigate the effect of a theory-based intervention on oral-health knowledge, attitudes and behaviours of early years staff (EYS), parents and nursery children.

METHODS

Qualitative research with staff and parents from eight nurseries through interviews/focus groups. An intervention was developed and piloted using pre-posttest design.

CLINICAL SETTING

Nurseries in deprived communities in Dundee, Scotland.

PARTICIPANTS

111 children aged 3-5 years attending nursery, including 79 parents and 8 nursery staff.

INTERVENTIONS

Staff session targeted outcome expectancies, subjective norms and self-efficacy for tooth-brushing in nursery using information provision, modelling and goal-setting, followed by a three-week intervention. Parent-child dyads received a leaflet with instructions for goal-setting, planning and monitoring home brushing. Tooth-brushing self-monitoring materials (e.g. two-minute timer, diaries) were used and certificates provided in the nursery as rewards.

OUTCOME MEASURES

EYS knowledge, attitudes and behaviours were assessed before and after the intervention using self-report questionnaires. Parents completed interviews assessing beliefs about tooth-brushing and their children's tooth-brushing behaviour at baseline and post-intervention follow-up.

RESULTS

Significant improvements in staff knowledge, but not attitudes, self-efficacy, or nursery tooth-brushing were reported. Parent-child dyads completing the intervention were not more likely to report their child carried out twice-daily tooth-brushing at home. The intervention did not improve parents' intentions to brush their child's teeth twice a day or beliefs about the ease of twice-daily tooth-brushing.

CONCLUSION

Only past behaviour significantly predicted posttest brushing. Parents who found brushing easier at baseline were more likely to complete the intervention. Recommendations are made regarding implementing psychological theory and methods into oral-health interventions.