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Published on: August 16, 2021
Patient decision-making regarding left ventricular assist devices : A multiple case study
Judy Dillworth1, Victoria Vaughan Dickson2, Alex Reyentovich3
1The Pless Center for Nursing Research, New York University, Rory Meyers College of Nursing, 433 First Avenue, #742, New York, NY 10010, United States; Department of Medicine, Heart Failure Program, Heart Transplant and Left Ventricular Assist Device Program, NYU Langone Medical Center, 530 1st Avenue, Skirball 9N, New York, NY 10016, United States.
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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