Deciding to Live (or Not) With a Left Ventricular Assist Device-a Thematic Analysis Exploring Factors Influencing the Decision-Making Process in Advanced Heart Failure Patients in Singapore

Background: It is often difficult for patients with advanced heart failure (HF) to decide whether to live with a left ventricular assist device (LVAD) or not. Little is known about their decisional needs prior to LVAD implantation and if these needs were met in the Asian cultural setting. Aims: We aimed to explore the influences, concerns, and needs surrounding the decision-making process of the LVAD implantation among multi-ethnic Asian patients with HF. Methods: Semi-structured interviews with HF patients and caregivers were conducted, based upon the grounded theory approach. Participants were purposively recruited from the inpatient and outpatient setting of the National Heart Centre Singapore. Results: A total of 31 patients and 11 caregivers participated. Mindsets that shaped decision-making ranged from "having no choice," "being reflective," "taking a gamble," and "fighting on." Instead of making a sole decision, many patients reported that decisions were shared with the family or medical team. Current LVAD patients who acted as patient ambassadors were also strong influences. Spiritual support was pivotal to decision-making for some participants. Goals influencing decision-making including protecting the family and life prolongation improving quality of life. Values held close included sanctity of life, trusting in a higher power, believing in pre-destination or karma, and preserving family harmony. Participants had concerns about cost, employment, and health outcomes. Conclusions: Asian LVAD patients and caregivers had culturally specific mindsets, goals, and values and concerns around decision-making. Our findings have implications for the design of interventions and supportive care models.

Adherence to cultural values and the internalization of sociocultural appearance ideals are associated with exercise dependence symptoms in Asian/Asian American men

This study examined sociocultural correlates of exercise dependence symptoms (EDSX) in young Asian/Asian American men. We hypothesized that greater adherence to Asian cultural values would be positively associated with EDSX and that the internalization of muscularity and thinness appearance ideals would exacerbate this link. Participants included 266 Asian/Asian American men (18-30y, Mage = 24.4 ± 3.6y; MBMI = 24.2 ± 5 kg/m²) enrolled in a larger study examining disordered eating and body image concerns in ethnically/racially diverse young men. Participants completed an online survey that assessed demographics, adherence to Asian values, internalization of muscularity and thinness appearance ideals, and EDSX. After adjusting for BMI, income, education, and presence of a psychiatric diagnosis, a linear regression model indicated that adherence to Asian values was significantly and positively associated with EDSX (B = 12.13, p = .036). Neither internalization of muscularity (p = .812) nor thinness (p = .967) appearance ideals moderated this association. However, independently, both internalization of muscularity (B = 10.93, p < .001) and thinness appearance ideals (B = 7.92, p < .001) were positively associated with EDSX. The current study highlights the importance of considering cultural factors, such as adherence to traditional norms, in our investigations of EDSX in young Asian/Asian American men and the need to develop tailored interventions for young men's disordered eating symptoms. Our data also support the link between sociocultural ideals of attractiveness and young men's excessive exercise behaviors, contributing to a robust body of literature highlighting the problems with a cultural emphasis on specific body sizes and shapes.