Patient decision-making regarding left ventricular assist devices

A multiple case study

Judy Dillworth, Victoria Vaughan Dickson, Alex Reyentovich, Michele Shedlin

Research output: Contribution to journalArticle

Abstract

Objectives: To understand how patients make decisions regarding a left ventricular assist device (LVAD). Design: A qualitative multiple case study design was used to explore the context and influence of individuals regarding patients’ decision-making processes through: 1) detailed, in-depth interviews of those mostly involved in the patient's decision and 2) pertinent data including observations, medical records, educational information and physical artifacts. Data clusters and patterns of co-occurring codes were examined using thematic analysis. Main outcome measures: Themes were extrapolated from individual case summaries to provide an in-depth analysis of each case and a cross-case analysis across the multiple cases. The predominant theme, consistent with other studies, was the salience of survival. Findings: This case study approach revealed new themes beyond those of prior studies. Patients considered: 1) self-care management for patients without a caregiver, 2) acceptability and future expectations of the LVAD and 3) the role of nurses in eliciting patients’ fears, values and preferences. Conclusion: The patients’ decision-making processes regarding an LVAD involve a cost-benefit analysis of the anticipated needs and consequences of the LVAD. Acceptability of the device is relevant to clinical practice and public policy. Nurses have a unique role in seeking patients’ concerns, an essential component of shared decision-making.

Original languageEnglish (US)
JournalIntensive and Critical Care Nursing
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Heart-Assist Devices
Decision Making
Self Care
Nurse's Role
Public Policy
Artifacts
Caregivers
Fear
Cost-Benefit Analysis
Medical Records
Nurses
Outcome Assessment (Health Care)
Interviews
Equipment and Supplies
Survival

Keywords

  • Decision-making
  • Heart failure
  • Left ventricular assist device (LVAD)
  • Mechanical circulatory support (MCS) devices
  • Multiple case study
  • Qualitative research

ASJC Scopus subject areas

  • Critical Care

Cite this

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title = "Patient decision-making regarding left ventricular assist devices: A multiple case study",
abstract = "Objectives: To understand how patients make decisions regarding a left ventricular assist device (LVAD). Design: A qualitative multiple case study design was used to explore the context and influence of individuals regarding patients’ decision-making processes through: 1) detailed, in-depth interviews of those mostly involved in the patient's decision and 2) pertinent data including observations, medical records, educational information and physical artifacts. Data clusters and patterns of co-occurring codes were examined using thematic analysis. Main outcome measures: Themes were extrapolated from individual case summaries to provide an in-depth analysis of each case and a cross-case analysis across the multiple cases. The predominant theme, consistent with other studies, was the salience of survival. Findings: This case study approach revealed new themes beyond those of prior studies. Patients considered: 1) self-care management for patients without a caregiver, 2) acceptability and future expectations of the LVAD and 3) the role of nurses in eliciting patients’ fears, values and preferences. Conclusion: The patients’ decision-making processes regarding an LVAD involve a cost-benefit analysis of the anticipated needs and consequences of the LVAD. Acceptability of the device is relevant to clinical practice and public policy. Nurses have a unique role in seeking patients’ concerns, an essential component of shared decision-making.",
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