Choices for Patients “Without a Choice”

Ottenberg, Abigale L.; Cook, Katlyn E.; Topazian, Rachel J.; Mueller, Luke; Mueller, Paul S.; Swetz, Keith M.

doi:10.1161/circoutcomes.113.000660

Cited by 32 publications

(32 citation statements)

References 20 publications

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“…Recent studies indicate that most patients feel gratitude for receiving the LVAD as it has improved quality of life; however, they also report little recollection of the decision to implant due to their failing health at the time of the consent. 16 In addition, some patients have reported feeling they had little choice but to consent when facing the alternative of death; whereas others made unrushed, thoughtful decisions to implant. 8 The literature highlights a need for improved patient/provider conversations, prior to implantation, that ensure patient appreciation of risks, benefits, and burdens of LVAD implantation and outline realistic expectations post-implantation.…”

Section: Introductionmentioning

confidence: 99%

Patients' decision making process and expectations of a left ventricular assist device pre and post implantation

et al. 2016

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Section: Introductionmentioning

confidence: 99%

Patients' decision making process and expectations of a left ventricular assist device pre and post implantation

et al. 2016

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“…13 These are the memories that come to define a healthcare experience and shape a patient's judgment of the care received; therefore, they influence subsequent health behaviors and are worth measuring despite their flaws. 13,14 The novel study by Ottenberg et al, 15 also in this issue of Circulation Cardiovascular Quality and Outcomes, provides further evidence of the need to systematically measure patient experiences. Their qualitative study describes patient experiences from pre-to postimplantation of left ventricular assist devices (LVAD) as destination therapy in patients with advanced heart failure.…”

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confidence: 97%

“…In fact, patients reported feeling overwhelmed by the high volume of information received. 15 Patient experiences can extend to nearly all facets of life for interventions such as LVAD. Patients and caregivers faced numerous mundane and daily challenges such as how to take a shower with an LVAD.…”

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confidence: 99%

“…For example, patients considering LVAD for destination therapy frequently cited that immediate implantation was their only choice despite the presence of other treatment options or timing choices for implantation. 15 Given the emotions surrounding advanced heart failure, patients struggle to consider (bring to mind) these other options and preferences. Preparedness planning presents the full range of options with their attendant experiences in a standardized manner to better facilitate patient awareness and consideration.…”

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confidence: 99%

“…4,8,15 Far more than a marketing slogan, patient centeredness is an important dimension of high-quality health care. The limitations of human decision making and interpersonal communication pertinent to health care may be predicted and ameliorated through the use of validated measures of patient centeredness.…”

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confidence: 99%

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Peering Inside the Black Box of Patient-Centered Care

Naik

2014

Circ: Cardiovascular Quality and Outcomes

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P atient centeredness is a distinct dimension of healthcare quality. Patient-centered care is respectful of and responsive to individual patient preferences, needs, and values in ways that guide treatment decisions.1 Translating patient centeredness into routine care is challenging. Citing evidence that patients often do not want a role in treatment decision making, many initially questioned the utility of engaging patients or eliciting their preferences.2,3 It is not surprising that many subjects enrolled in older studies of medical decision making would endorse passive decision making styles, given the paucity of tools to facilitate meaningful patient or caregiver engagement. When such tools were available, they were often overly complex and technical with little appreciation for health literacy, numeracy, or cognitive biases. The purpose of these tools was to facilitate decision making for clinicians rather than explore or uncover patient preferences, values, and goals. In essence, these earlier studies attempted to measure patient participation, experiences, and preferences within the context of clinician-centric medical encounters. Articles see p 353, 360, 368The results described by Dunlay et al 4 in this issue of Circulation Cardiovascular Quality and Outcomes are illustrative of these early attempts in understanding patient centeredness within the context of a clinician-centered healthcare environment. Their study sought to better understand the endof-life preferences of patients with heart failure and how those preferences changed during the disease course and, in particular, during hospitalizations for acute exacerbation. 5 The focus on do-not-resuscitate (DNR) orders as a surrogate is indicative of our limited capacity to clearly understand, elicit, and document end-of-life preferences. DNR orders are rudimentary measures of patient values and preferences for end-of-life care; orders are often placed with little or no previous discussions and are largely for the purpose of clinician decision making. 5,6 Dunlay et al 4 found that changes in DNR status in patients with heart failure are associated with acute heart failure exacerbations and with predictors of mortality (eg, age, functional impairment, malignancy, and comorbid chronic obstructive pulmonary disease). The disconnect between DNR orders and advance care planning is evident by the finding that patients with class 3 or 4 heart failure symptoms were less likely to have DNR orders in place on study enrollment. 4 The results of this study highlight the lack of standardized, patient-centered measures of advanced care planning. In contrast, the presence of DNR orders has surprisingly powerful effects on clinicians' decision making that go far beyond the simple intent of documenting the patient's preferences for resuscitation. In a previous study, Beach and Morrison 7 found that the presence of a DNR order was associated with significantly lower willingness to draw blood cultures, place central lines, or provide blood transfusions among physicians. T...

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Psychosocial and Palliative Aspects of VAD Care

Abshire

Nakagawa²

2022

A Guide to Mechanical Circulatory Support

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Choices for Patients “Without a Choice”

Cited by 32 publications

References 20 publications

Patients' decision making process and expectations of a left ventricular assist device pre and post implantation

Patients' decision making process and expectations of a left ventricular assist device pre and post implantation

Peering Inside the Black Box of Patient-Centered Care

Psychosocial and Palliative Aspects of VAD Care

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