Decision-Making for Destination Therapy Left Ventricular Assist Devices: Implications for Caregivers

Colleen K. McIlvennan, Jacqueline Jones, Larry A. Allen, Joann Lindenfeld, Keith M. Swetz, Carolynph Nowels, Daniel D. Matlock

Research output: Contribution to journalArticle

28 Scopus citations

Abstract

Implanting centers often require the identification of a dedicated caregiver before destination therapy left ventricular assist device (DT LVAD) implantation; however, the caregiver experience surrounding this difficult decision is relatively unexplored. Methods and Results-From October 2012 through July 2013, we conducted semistructured, in-depth interviews with caregivers of patients considering DT LVAD. Data were analyzed using a mixed inductive and deductive approach. We interviewed 17 caregivers: 10 caregivers of patients living with DT LVAD, 6 caregivers of patients who had died with DT LVAD, and 1 caregiver of a patient who had declined DT LVAD. The themes identified, which could also be considered dialectical tensions, are broadly interpreted under 3 domains mapping to decision context, process, and outcome: (1) the stark decision context, with tension between hope and reality; (2) the challenging decision process, with tension between wanting loved ones to live and wanting to respect loved ones' wishes; and (3) the downstream decision outcome, with tension between gratitude and burden. Conclusions-Decision-making surrounding DT LVAD should incorporate decision support for patients and caregivers. This should include a focus on caregiver burden and the predictable tensions that caregivers experience.

Original languageEnglish (US)
Pages (from-to)172-178
Number of pages7
JournalCirculation: Cardiovascular Quality and Outcomes
Volume8
Issue number2
DOIs
StatePublished - Mar 21 2015

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Keywords

  • Heart failure
  • patient-centered care

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

McIlvennan, C. K., Jones, J., Allen, L. A., Lindenfeld, J., Swetz, K. M., Nowels, C., & Matlock, D. D. (2015). Decision-Making for Destination Therapy Left Ventricular Assist Devices: Implications for Caregivers. Circulation: Cardiovascular Quality and Outcomes, 8(2), 172-178. https://doi.org/10.1161/CIRCOUTCOMES.114.001276