Decision-making for destination therapy left ventricular assist devices: implications for caregivers

Area of Science:

• Cardiology
• Medical Ethics
• Patient Support

Background:

• Destination therapy left ventricular assist device (DT LVAD) implantation often requires identifying a dedicated caregiver.
• The caregiver experience during the DT LVAD decision-making process is not well understood.

Purpose of the Study:

• To explore the experiences and challenges faced by caregivers of patients considering DT LVAD implantation.
• To identify key themes and tensions within the caregiver decision-making process.

Main Methods:

• Conducted semistructured, in-depth interviews with 17 caregivers of patients considering DT LVAD.
• Utilized a mixed inductive and deductive approach for data analysis.
• Included caregivers of patients living with DT LVAD, deceased patients, and those who declined the device.

Main Results:

• Identified three primary domains of caregiver experience: decision context, process, and outcome.
• Decision context revealed tensions between hope and reality.
• Decision process highlighted conflicts between wanting loved ones to live and respecting their wishes; outcome involved gratitude versus burden.

Conclusions:

• Decision-making for DT LVAD requires integrated patient and caregiver support.
• Support should address caregiver burden and predictable emotional tensions.
• Acknowledging and addressing caregiver experiences is crucial for effective DT LVAD decision-making.