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Complex Decision-Making in Heart Failure: A Systematic Review and Thematic Analysis
Aimee V Hamel1, Joseph E Gaugler, Carolyn M Porta
1Aimee V. Hamel, MN, RN Nursing Student, School of Nursing, University of Minnesota, Twin Cities, Minneapolis. Joseph E. Gaugler, PhD Professor, School of Nursing, University of Minnesota, Twin Cities, Minneapolis. Carolyn M. Porta, PhD, MPH, RN, SANE-A Associate Professor, School of Nursing, University of Minnesota Y Twin Cities. Niloufar Niakosari Hadidi, PhD, APRN, CNS-BC, FAHA Associate Professor, School of Nursing, University of Minnesota, Twin Cities, Minneapolis.
The Journal of Cardiovascular Nursing
|December 13, 2017
Summary
Understanding shared decision-making in heart failure is crucial. This review identifies common themes in treatment choices like defibrillators and transplantation to improve patient care.
Area of Science:
- Cardiology
- Decision Science
- Health Psychology
Background:
- Heart failure management involves complex patient decisions regarding advanced therapies.
- Understanding the decision-making process across treatments like defibrillators, mechanical support, and transplantation is vital for shared decision-making.
- Identifying commonalities in decision-making can guide healthcare providers in supporting patients.
Purpose of the Study:
- To examine complex treatment decision-making in heart failure, focusing on implantable cardiac defibrillators, ventricular assist devices, and cardiac transplantation.
- To identify commonalities and key decision points in the treatment process for advanced heart failure therapies.
Main Methods:
- A systematic review of qualitative studies was conducted using multiple databases (MEDLINE, CINAHL, PsycINFO, Web of Science).
- A 3-step synthesis process was employed to identify emergent themes and subthemes from the included literature.
- Twelve English-language studies involving patients, caregivers, and clinicians were included.
Main Results:
- Common themes across treatment decisions included 'processing the decision,' 'timing and prognostication,' and 'considering the future.'
- Subthemes detailed information processing, decision-making dynamics, timing, health status evaluation, and future considerations.
- Decisions to undergo or decline advanced therapies were explored.
Conclusions:
- Communalities exist across different advanced heart failure therapies regarding the timing of discussions, information delivery, and future outlook.
- Further exploration of these commonalities can enhance patient-centered care and optimize shared decision-making interventions.
- Recognizing shared decision-making patterns supports improved patient outcomes and provider communication.
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