"We Don't Really Know Each Other": A Mixed Methods Study Exploring Patient-Clinician Values-Centered Discussions...

Providing care aligned with patient values is key to high-quality cardiovascular care. However, it is unclear how recipients of a ventricular assist device (VAD) engage in values-centered discussions during the postimplantation period.

To understand how recipients of a VAD engage in conversations focused on clarifying what matters most.

Sequential explanatory mixed methods study. Adult recipients of a VAD were recruited from a Southeastern U.S. outpatient clinic. Participants completed a cross-sectional survey characterizing values discussions (with whom, who is present, timing, frequency, location, feelings). A subset completed a semi-structured interview to provide a richer understanding of survey findings.

Survey respondents (response rate 31%; N = 32) were 37 to 77 years, mostly male (59%) and non-Hispanic Black (53%). Qualitative analysis (n = 12) identified 3 themes: (1) Relational trust and emotional safety, (2) Timing and readiness, and (3) Contextual fit and communication environment. Synthesis of findings revealed congruence between survey and interview data. Patients indicated comfort with trusted, approachable individuals who were willing/able to offer support (with whom/who is present); acceptance and clarity about their new reality/identity (timing), trusting relationships built over time (frequency), and in-person interactions (location) were key; negative experiences emerged from frustration, conflict, negative attitudes, and lack of understanding (feelings).

Findings highlight the importance of relational trust, emotional readiness, and a supportive communication environment in facilitating values-centered discussions and offer practical guidance for nurses to foster meaningful, values-centered discussions by prioritizing continuity, accessibility, and emotional safety in their interactions.