Perspectives from mechanical circulatory support coordinators on the pre-implantation decision process for destination therapy left ventricular assist devices

Abstract

Objective: To understand mechanical circulatory support (MCS) coordinators' perspectives related to destination therapy left ventricular assist devices (DT LVAD) decision making.

Background: MCS coordinators are central to the team that interacts with patients considering DT LVAD, and are well positioned to comment upon the pre-implantation process.

Methods: From August 2012 to January 2013, MCS coordinators were recruited to participate in semi-structured, in-depth interviews. Established qualitative approaches were used to analyze and interpret data.

Results: Eighteen MCS coordinators from 18 programs were interviewed. We found diversity in coordinators' roles and high programmatic variability in how DT LVAD decisions are approached. Despite these differences, three themes were consistently recommended: 1) DT LVAD is a major patient-centered decision: "you're your best advocate… this may not be the best choice for you"; 2) this decision benefits from an iterative, multidisciplinary process: "It is not a one-time conversation"; and 3) this process involves a tension between conveying enough detail about the process yet not overwhelming patients: "It's sometimes hard to walk that line to not scare them but not paint a rainbow and butterflies picture."

Conclusions: MCS coordinators endorsed a shared decision-making process that starts early, uses non-biased educational materials, and involves a multidisciplinary team sensitive to the tension between conveying enough detail about the therapy yet not overwhelming patients.

Keywords: Destination therapy; Health-related quality of life; Heart failure; Heart-assist device; Patient-centered care.