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Values-Centered Discussions Among Family Caregivers of Patients with Left Ventricular Assist Devices: A Mixed Methods
Ashmita Thapa1, Martha Abshire Saylor2, Mireille Chehade3
1College of Nursing, University of Tennessee Knoxville, Knoxville, TN, USA.
Background:
Family caregivers of left ventricular assist device (LVAD) recipients play a central role in managing complex care and navigating ongoing healthcare decisions. Although personal values may influence caregiving experiences and decision-making, little is known about how caregivers engage in values-centered discussions with the healthcare team.
Objective:
To examine LVAD caregivers' engagement in values-centered discussions and identify factors influencing these interactions.
Methods:
A sequential explanatory mixed methods study among LVAD caregivers at an outpatient mechanical circulatory support clinic in the Southeastern United States. Survey data were analyzed using descriptive statistics to summarize patterns of values-centered discussions. Interviews with a subset of participants were analyzed using thematic analysis to identify factors influencing these interactions. Quantitative and qualitative findings were integrated using joint displays.
Results:
Caregivers (N=32) reported high levels of feeling heard and understood in healthcare interactions (median [IQR], 3.50 [3.00-4.00] and moderate assertiveness in communicating care-related concerns (median [IQR], 7.00 [4.00-8.00]). Values discussions most often occurred with spouses/partners (75%), family members (69%), and LVAD coordinators (56%). Discussions were more common after implantation (89%) and during hospitalizations (93%) and clinic visits (86%) than via telehealth (31%). Three themes (n=11) explained these patterns: emotional readiness, relational trust, and situational context. Emotional overwhelm in the early post-implant period limited discussions, whereas trust, accessibility, and longitudinal relationships facilitated engagement.
Conclusions:
Values-centered discussions depend not only on opportunity but also emotional readiness, healthcare team relationships, and care context. Prioritizing relationship-building and ongoing opportunities for discussion may enhance engagement and support more value-concordant advanced heart failure care.