TY - JOUR
T1 - Health Literacy in Patients Considering a Left Ventricular Assist Device
T2 - Findings From the DECIDE-LVAD Trial
AU - Raymer, DAVID S.
AU - ALLEN, LARRY A.
AU - CHAUSSEE, ERIN L.
AU - MCILVENNAN, COLLEEN K.
AU - THOMPSON, JOCELYN S.
AU - FAIRCLOUGH, DIANE L.
AU - DUNLAY, SHANNON M.
AU - MATLOCK, DANIEL D.
AU - LARUE, SHANE J.
N1 - Funding Information:
This work was supported by a Patient-Centered Outcomes Research Institute (PCORI) Program Award (CDR-1310-06998). All statements in this report, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of PCORI, its Board of Governors, or Methodology Committee. This work was also supported in part by the National Heart, Lung and Blood Institute (1K23HL105896-01, Allen), the Heart Failure Society of America (McIlvennan), the National Institute on Aging (1K23AG040696, Matlock), and REDCap database hosting through University of Colorado supported by NIH/NCRR Colorado CTSI (Grant Number UL1 TR001082). Trial Registration: clinicaltrials.gov Identifier: NCT02344576
Funding Information:
Dr. Allen receives grant funding from the American Heart Association, the National Institutes of Health and Patient Centered Outcomes Research Institute and consulting fees from ACI Clinical, Amgen/Cytokinetics, Boston Scientific, the Duke Clinical Research Institute, Janssen, and Novartis. No other disclosures are reported.
Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/8
Y1 - 2022/8
N2 - Objective: To assess the interaction of health literacy and a shared intervention concerning decision quality in patients considering the destination therapy of left ventricular assist device (DT LVAD) implantation. Background: Evidence is limited for the use of decision aids by patients with low health literacy and with life-threatening illnesses. Methods: We performed a secondary analysis of the DECIDE-LVAD Trial, a randomized, stepped-wedge trial conducted from 2015–2017 in the United States. The intervention was the integration of a formal shared decision-making intervention. The main outcome was decision quality as measured by LVAD knowledge and values-treatment concordance. Two components of health literacy were measured by the Rapid Estimate of Adult Literacy in Medicine and Subjective Numeracy Scale instruments. Results: Of the 228 patients studied, 44% (n = 101) received the formal shared decision-making intervention, and half had low health literacy. Knowledge of LVAD improved for patients with low literacy in the intervention group compared to the control group: the difference in increased knowledge score was 10.6%; P = 0.04. Values-treatment concordance improved significantly for patients with low literacy in the intervention group compared to the control group: the median improvement in values-treatment correlation coefficient was 0.43; P = 0.03. These benefits were not significant in those with adequate literacy (n = 171). Patients with low numeracy (n = 94) did not show significant improvements in either measure of decision quality, and patients with adequate numeracy (n = 134) showed improvement in LVAD knowledge but not in values-treatment concordance. Conclusions: Patients considering DT LVAD implantation with low literacy showed improvement in decision quality after the integration of a shared decision-making intervention.
AB - Objective: To assess the interaction of health literacy and a shared intervention concerning decision quality in patients considering the destination therapy of left ventricular assist device (DT LVAD) implantation. Background: Evidence is limited for the use of decision aids by patients with low health literacy and with life-threatening illnesses. Methods: We performed a secondary analysis of the DECIDE-LVAD Trial, a randomized, stepped-wedge trial conducted from 2015–2017 in the United States. The intervention was the integration of a formal shared decision-making intervention. The main outcome was decision quality as measured by LVAD knowledge and values-treatment concordance. Two components of health literacy were measured by the Rapid Estimate of Adult Literacy in Medicine and Subjective Numeracy Scale instruments. Results: Of the 228 patients studied, 44% (n = 101) received the formal shared decision-making intervention, and half had low health literacy. Knowledge of LVAD improved for patients with low literacy in the intervention group compared to the control group: the difference in increased knowledge score was 10.6%; P = 0.04. Values-treatment concordance improved significantly for patients with low literacy in the intervention group compared to the control group: the median improvement in values-treatment correlation coefficient was 0.43; P = 0.03. These benefits were not significant in those with adequate literacy (n = 171). Patients with low numeracy (n = 94) did not show significant improvements in either measure of decision quality, and patients with adequate numeracy (n = 134) showed improvement in LVAD knowledge but not in values-treatment concordance. Conclusions: Patients considering DT LVAD implantation with low literacy showed improvement in decision quality after the integration of a shared decision-making intervention.
KW - Health literacy
KW - heart failure
KW - left ventricular assist device
KW - patient decision aid
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U2 - 10.1016/j.cardfail.2022.04.009
DO - 10.1016/j.cardfail.2022.04.009
M3 - Article
C2 - 35569806
AN - SCOPUS:85133296847
SN - 1071-9164
VL - 28
SP - 1318
EP - 1325
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
IS - 8
ER -