Shared Decision-Making Beneficial for Destination Therapy LVAD
FRIDAY, March 2, 2018 -- A shared decision support intervention is beneficial for patients considering destination therapy left ventricular assist device (DT LVAD) placement, according to a study published online Feb. 26 in JAMA Internal Medicine.
Larry A. Allen, M.D., from the University of Colorado School of Medicine in Aurora, and colleagues examined the effectiveness of a shared decision support intervention among 248 patients being considered for DT LVAD. After randomly varying time in usual care, sites were transitioned from usual care to an intervention that included clinical education and use of patient decision aids (135 and 113 patients enrolled during control and intervention periods, respectively).
The researchers observed improvements in patient knowledge (mean test performance) during the decision-making period in the control group (from 59.5 to 64.9 percent) and in the intervention group (from 59.1 to 70 percent). The stated values at one month were a mean of 2.37 and 3.33 in the control and intervention groups, respectively (scale 1, do everything I can to live longer, versus scale 10, live with whatever time I have left). At one month, patient-reported treatment choice favored LVAD more in the control group than the intervention group (59.5 versus 91.3 percent). The intervention group had a stronger correlation between stated values and patient-reported treatment choice at one month; no improved correlation was seen between stated values and actual treatment received by six months for the intervention versus the control group.
"These results suggest that institutional culture and processes can influence medical decisions in life-threatening illness," the authors write.
Several authors disclosed financial ties to the pharmaceutical industry.
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Posted: March 2018