Decision Aid Implementation among Left Ventricular Assist Device Programs Participating in the DECIDE-LVAD Stepped-Wedge Trial

Daniel D. Matlock, Colleen K. McIlvennan, Jocelyn S. Thompson, Megan A. Morris, Grace Venechuk, Shannon M. Dunlay, Shane J. LaRue, Eldrin F. Lewis, Chetan B. Patel, Laura Blue, Erin L. Chaussee, Russell E. Glasgow, Mary Norine Walsh and Larry A. Allen
Additional contact information
Daniel D. Matlock: Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA
Colleen K. McIlvennan: Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
Jocelyn S. Thompson: Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
Megan A. Morris: Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
Grace Venechuk: Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
Shannon M. Dunlay: Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
Shane J. LaRue: Washington University School of Medicine, St. Louis, MO, USA
Eldrin F. Lewis: Brigham and Women’s Hospital, Boston, MA, USA
Chetan B. Patel: Duke University Medical Center, Durham, NC, USA
Laura Blue: Duke University Medical Center, Durham, NC, USA
Erin L. Chaussee: Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
Russell E. Glasgow: Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
Mary Norine Walsh: St. Vincent Heart Center, Division of Cardiology, Indianapolis, IN, USA
Larry A. Allen: Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA

Medical Decision Making, 2020, vol. 40, issue 3, 289-301

Abstract: Background. Despite demonstrated efficacy, patient decision aids (DAs) are rarely used in clinical practice in the absence of coverage mandates. Deciding whether to pursue a left ventricular assist device (LVAD) is a major, preference-sensitive decision—ideal for exploring implementation of a DA. Methods. We conducted a type II effectiveness-implementation hybrid trial at 6 LVAD programs using a stepped-wedge cluster-randomized design. Using the RE-AIM framework, we collected both quantitative and qualitative outcomes, including a checklist collected by study staff for each enrolled patient regarding DA use and interviews with LVAD program clinicians preintervention, 6 months postintervention, and at the conclusion of the study. Results. From June 2015 to January 2017, 248 patients and their caregivers were enrolled. A total of 69 interviews were conducted with 48 clinicians at 3 time points. The DA reached 95% of eligible patients. Adoption was 100%, as all sites approached agreed to participate in the trial. Interviews revealed several themes related to the implementation of the DA: clinicians had a strong desire to ensure patients were informed and embraced the DA. Despite this, they reported communication challenges among their team that impeded implementation. Five of the 6 sites have maintained use of the DA following the trial; 1 site reported concerns about decreased procedural volume with use of the DA as a reason for discontinuation. Conclusions. In this hybrid trial, a DA for patients considering LVADs and their caregivers demonstrated high reach. Adoption and implementation were facilitated by a strong desire to ensure that patients were well informed. Future dissemination research and practice should attend to concerns about procedure volume and coverage mandates and facilitate ongoing communication at sites using the DA.

Keywords: decision aid; heart failure; implementation; shared decision making; ventricular assist device (search for similar items in EconPapers)
Date: 2020
References: View complete reference list from CitEc
Citations: View citations in EconPapers (1)

Downloads: (external link)
https://journals.sagepub.com/doi/10.1177/0272989X20915227 (text/html)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:40:y:2020:i:3:p:289-301

DOI: 10.1177/0272989X20915227

Access Statistics for this article

More articles in Medical Decision Making
Bibliographic data for series maintained by SAGE Publications ().