Reasons why eligible candidates decline left ventricular assist device placement

Courtenay R. Bruce, Kristin M. Kostick, Estevan D. Delgado, Lidija A. Wilhelms, Robert J. Volk, Martin L. Smith, Sheryl A. McCurdy, Matthias Loebe, Jerry D. Estep, Jennifer S. Blumenthal-Barby

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background A greater understanding of how beliefs and perceptions inform LVAD placement refusals can help ensure that standards for informed decision making are met. We report on the factors that influence refusal and what accounts for changes in decliners' decision-making process when, and if, that occurs. Method and Results We identified candidates (8 bridge to transplant; 6 destination therapy, 7 without designation) who declined LVAD placement (n = 21), 11 of whom were identified prospectively from February 2014 to March 2015, and 10 of whom were identified retrospectively with the use of our program database. Of these 21 decliners, 11 candidates persistently declined LVAD placement, with a median time of 175 days elapsing between time of LVAD offer and March 4, 2015. Ten candidates declined for an average of 224 days before agreeing to LVAD placement. From March 2014 to March 2015, we conducted structured interviews with LVAD decliners. Interviews were audio recorded, transcribed verbatim, and analyzed quantitatively with the use of Atlas.ti. The findings reflect that refusal can evolve over time. Decliners report that their initial refusals were made reflexively, but the 10 decliners who ultimately opted for LVAD placement changed their decisions as symptoms worsened. Decliners have concerns about the impacts of LVAD treatment on mobility, and they distrust LVAD technology. Some decliners believe LVAD placement would affect their ability to receive a transplant. Finally, decliners believe that they are not sick enough for LVAD placement when they are stabilized with medical management. Conclusions Decliners' perspectives are integral for improving informed consent and refusal processes. Our analysis revealed decliners' decision-making processes and factors influencing their decisions. We provide several clinically based practical recommendations based on our findings.

Original languageEnglish (US)
Pages (from-to)835-839
Number of pages5
JournalJournal of Cardiac Failure
Volume21
Issue number10
DOIs
StatePublished - Oct 1 2015
Externally publishedYes

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Heart-Assist Devices
Decision Making
Interviews
Transplants
Aptitude
Atlases
Informed Consent
Databases
Technology
Therapeutics

Keywords

  • Decision making
  • ethics
  • informed consent
  • left ventricular assist device

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Bruce, C. R., Kostick, K. M., Delgado, E. D., Wilhelms, L. A., Volk, R. J., Smith, M. L., ... Blumenthal-Barby, J. S. (2015). Reasons why eligible candidates decline left ventricular assist device placement. Journal of Cardiac Failure, 21(10), 835-839. https://doi.org/10.1016/j.cardfail.2015.06.008

Reasons why eligible candidates decline left ventricular assist device placement. / Bruce, Courtenay R.; Kostick, Kristin M.; Delgado, Estevan D.; Wilhelms, Lidija A.; Volk, Robert J.; Smith, Martin L.; McCurdy, Sheryl A.; Loebe, Matthias; Estep, Jerry D.; Blumenthal-Barby, Jennifer S.

In: Journal of Cardiac Failure, Vol. 21, No. 10, 01.10.2015, p. 835-839.

Research output: Contribution to journalArticle

Bruce, CR, Kostick, KM, Delgado, ED, Wilhelms, LA, Volk, RJ, Smith, ML, McCurdy, SA, Loebe, M, Estep, JD & Blumenthal-Barby, JS 2015, 'Reasons why eligible candidates decline left ventricular assist device placement', Journal of Cardiac Failure, vol. 21, no. 10, pp. 835-839. https://doi.org/10.1016/j.cardfail.2015.06.008
Bruce CR, Kostick KM, Delgado ED, Wilhelms LA, Volk RJ, Smith ML et al. Reasons why eligible candidates decline left ventricular assist device placement. Journal of Cardiac Failure. 2015 Oct 1;21(10):835-839. https://doi.org/10.1016/j.cardfail.2015.06.008
Bruce, Courtenay R. ; Kostick, Kristin M. ; Delgado, Estevan D. ; Wilhelms, Lidija A. ; Volk, Robert J. ; Smith, Martin L. ; McCurdy, Sheryl A. ; Loebe, Matthias ; Estep, Jerry D. ; Blumenthal-Barby, Jennifer S. / Reasons why eligible candidates decline left ventricular assist device placement. In: Journal of Cardiac Failure. 2015 ; Vol. 21, No. 10. pp. 835-839.
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abstract = "Background A greater understanding of how beliefs and perceptions inform LVAD placement refusals can help ensure that standards for informed decision making are met. We report on the factors that influence refusal and what accounts for changes in decliners' decision-making process when, and if, that occurs. Method and Results We identified candidates (8 bridge to transplant; 6 destination therapy, 7 without designation) who declined LVAD placement (n = 21), 11 of whom were identified prospectively from February 2014 to March 2015, and 10 of whom were identified retrospectively with the use of our program database. Of these 21 decliners, 11 candidates persistently declined LVAD placement, with a median time of 175 days elapsing between time of LVAD offer and March 4, 2015. Ten candidates declined for an average of 224 days before agreeing to LVAD placement. From March 2014 to March 2015, we conducted structured interviews with LVAD decliners. Interviews were audio recorded, transcribed verbatim, and analyzed quantitatively with the use of Atlas.ti. The findings reflect that refusal can evolve over time. Decliners report that their initial refusals were made reflexively, but the 10 decliners who ultimately opted for LVAD placement changed their decisions as symptoms worsened. Decliners have concerns about the impacts of LVAD treatment on mobility, and they distrust LVAD technology. Some decliners believe LVAD placement would affect their ability to receive a transplant. Finally, decliners believe that they are not sick enough for LVAD placement when they are stabilized with medical management. Conclusions Decliners' perspectives are integral for improving informed consent and refusal processes. Our analysis revealed decliners' decision-making processes and factors influencing their decisions. We provide several clinically based practical recommendations based on our findings.",
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N2 - Background A greater understanding of how beliefs and perceptions inform LVAD placement refusals can help ensure that standards for informed decision making are met. We report on the factors that influence refusal and what accounts for changes in decliners' decision-making process when, and if, that occurs. Method and Results We identified candidates (8 bridge to transplant; 6 destination therapy, 7 without designation) who declined LVAD placement (n = 21), 11 of whom were identified prospectively from February 2014 to March 2015, and 10 of whom were identified retrospectively with the use of our program database. Of these 21 decliners, 11 candidates persistently declined LVAD placement, with a median time of 175 days elapsing between time of LVAD offer and March 4, 2015. Ten candidates declined for an average of 224 days before agreeing to LVAD placement. From March 2014 to March 2015, we conducted structured interviews with LVAD decliners. Interviews were audio recorded, transcribed verbatim, and analyzed quantitatively with the use of Atlas.ti. The findings reflect that refusal can evolve over time. Decliners report that their initial refusals were made reflexively, but the 10 decliners who ultimately opted for LVAD placement changed their decisions as symptoms worsened. Decliners have concerns about the impacts of LVAD treatment on mobility, and they distrust LVAD technology. Some decliners believe LVAD placement would affect their ability to receive a transplant. Finally, decliners believe that they are not sick enough for LVAD placement when they are stabilized with medical management. Conclusions Decliners' perspectives are integral for improving informed consent and refusal processes. Our analysis revealed decliners' decision-making processes and factors influencing their decisions. We provide several clinically based practical recommendations based on our findings.

AB - Background A greater understanding of how beliefs and perceptions inform LVAD placement refusals can help ensure that standards for informed decision making are met. We report on the factors that influence refusal and what accounts for changes in decliners' decision-making process when, and if, that occurs. Method and Results We identified candidates (8 bridge to transplant; 6 destination therapy, 7 without designation) who declined LVAD placement (n = 21), 11 of whom were identified prospectively from February 2014 to March 2015, and 10 of whom were identified retrospectively with the use of our program database. Of these 21 decliners, 11 candidates persistently declined LVAD placement, with a median time of 175 days elapsing between time of LVAD offer and March 4, 2015. Ten candidates declined for an average of 224 days before agreeing to LVAD placement. From March 2014 to March 2015, we conducted structured interviews with LVAD decliners. Interviews were audio recorded, transcribed verbatim, and analyzed quantitatively with the use of Atlas.ti. The findings reflect that refusal can evolve over time. Decliners report that their initial refusals were made reflexively, but the 10 decliners who ultimately opted for LVAD placement changed their decisions as symptoms worsened. Decliners have concerns about the impacts of LVAD treatment on mobility, and they distrust LVAD technology. Some decliners believe LVAD placement would affect their ability to receive a transplant. Finally, decliners believe that they are not sick enough for LVAD placement when they are stabilized with medical management. Conclusions Decliners' perspectives are integral for improving informed consent and refusal processes. Our analysis revealed decliners' decision-making processes and factors influencing their decisions. We provide several clinically based practical recommendations based on our findings.

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