Development and validation of a patient-centered knowledge scale for left ventricular assist device placement

Kostick, Kristin M.; Minard, Charles G.; Wilhelms, Lidija A.; Delgado, Estevan D.; Abraham, Mackenzie N.; Bruce, Courtenay R.; Estep, Jerry D.; Loebe, Matthias; Volk, Robert J.; Blumenthal‐Barby, Jennifer

doi:10.1016/j.healun.2016.01.015

Cited by 18 publications

(14 citation statements)

References 26 publications

(32 reference statements)

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“…Our group recently published an instrument primarily designed to assess patients' comprehension for LVAD placement. 18 Here, based on these findings, we encourage adapting and adopting such instruments for caregivers to assess caregiver comprehension. …”

Section: Caregiver Understandingmentioning

confidence: 96%

Caregivers of Patients With Left Ventricular Assist Devices

Bruce

Minard

Wilhelms

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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Support emphasize the importance of caregiver support for left ventricular assist device (LVAD) placement, recommending that a lack of support should serve as a relative contraindication to device placement.1 Despite the integral role that caregivers are expected to play, findings from studies on LVAD caregivers are limited. Most of these studies are qualitative, exclusively focus on caregivers' experiences or burdens, and fail to examine specific mechanisms of support and the impact of caregiver support on patient mortality or morbidity events. 2-9How caregivers contribute to positive or negative patient mortality or morbidity events is unclear. Without this foundational understanding, there will be variability across LVAD programs and among candidates with regard to how much emphasis to place on caregiver support, how such support should be assessed, and at what threshold an absence of support becomes Background-How caregivers contribute to positive or negative outcomes for left ventricular assist device (LVAD) patients remains unclear. Our primary study objectives were to (1) identify caregiver support attributes through a retrospective chart review of social workers' psychosocial assessments for LVAD patients and (2) determine how these attributes associated with patients' post-LVAD placement mortality and Interagency Registry for Mechanically Assisted Circulatory Support-defined morbidity events. Methods and Results-We retrospectively reviewed and recorded social workers' clinical assessments of adult patients implanted with durable continuous-flow LVADs as bridge to transplant, destination therapy, or bridge to decision from January 2010 to December 2014. Associations between caregiver characteristics and patient mortality and morbidity events were analyzed using Kaplan-Meier curves and Cox proportional hazards regression. Patient follow-up time was calculated as the time from hospital discharge until the earliest among death with LVAD, transplant, or the last day of the study (December 31, 2015). Patients were censored for death with LVAD at the time of transplant or the last day of the study. A total of 96 LVAD recipients were included in this study. Having a caregiver who understands the severity of the illness and options available to the patient (as determined and documented by the social worker; P=0.01), a caregiver who has identified a backup plan (P=0.02), and a caregiver who is able to provide logistical support (P=0.04) significantly mitigated risk of death. The risk of death for an LVAD patient was also significantly lower among those who have at least 1 adult child who lives within 50 miles (P=0.03) and those who have an extended family who can care for the patient (P=0.03). The risk of death was 3.1× more likely among patients who live alone compared with those who do not live alone (P=0.04). No caregiver characteristics were significantly associated with morbidity. Conclusions-This exploratory, hypothesis-generating study suggests that mortality after LVAD placement is impacted by caregiver u...

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Section: Caregiver Understandingmentioning

confidence: 96%

Caregivers of Patients With Left Ventricular Assist Devices

Bruce

Minard

Wilhelms

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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“…A 20-item Knowledge Scale (KS) was used to assess candidate knowledge. The LVAD KS’s development and validation is described in detail elsewhere [8]. In summary, the LVAD KS was developed using inductive qualitative methods and deductive quantitative validation of scale items to determine content and face validity.…”

Section: Methodsmentioning

confidence: 99%

“…To our knowledge, only three standardized measures for evaluating LVAD candidate knowledge exist that reflect the breadth of information relayed during education including self-care, but also treatment options, lifestyle changes, benefits and risks [8,9,10]. The limitations of some of these measures include open-ended questions [9], which are difficult to consistently score, and specificity to destination therapy [10], which limits its clinical reach.…”

Section: Introductionmentioning

confidence: 99%

Identifying Knowledge Gaps among LVAD Candidates

Trejo

Kostick

Estep

et al. 2019

JCM

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Education is an important aspect of evaluation and consent for left ventricular assist device (LVAD) candidates. A better understanding of candidate knowledge during the education process can help identify knowledge gaps and improve informed consent processes. This paper presents the results from a validated, LVAD-specific Knowledge Scale administered to candidates before and after education to identify items most and least frequently answered correctly. At baseline and 1-week, both candidates educated with a standard education and an LVAD-specific decision aid were most likely to answer logistical items relating to support and self-care correctly with ≥90% of candidates answering these items correctly after education. Candidates were least likely to answer questions about risks, transplant eligibility, and expenses correctly with <60% of candidates answering them correctly after education. Items with the greatest improvement in correct answers from baseline to 1-week were primarily related to the logistics of living with an LVAD. Candidates educated with the decision aid showed significant improvements on more knowledge items including those related to the forecasting of recovery and complications when compared to candidates educated with a standard education. The 20-item scale provides a standardized way for clinicians to identify knowledge gaps with LVAD candidates, potentially helping to tailor education. Targeted improvements in LVAD education should focus on the understanding of risk and potential complications to ensure that decision-making and informed consent processes emphasize both the patient and clinicians’ conceptualizations of knowledge needs for informed consent.

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“…and 3) Provide ongoing support to LVAD coordinators to facilitate development of sustainable practices for long-term DA use in their programs. The implementation setting includes nine U.S. hospitals, including ve that participated in our original randomized controlled trial (RCT) of the DA and four that had no prior experience with the LVAD DA (20). None of the nine sites were actively using the DA at the beginning of the D&I project due to staff turnover since the RCT.…”

Section: Description Of Implementation Projectmentioning

confidence: 99%

“…Further, few studies explicitly compare feature pro les of different implementation sites with varying levels of success in order to gain insight into what site attributes, practices or attitudinal orientations facilitate implementation success (16,17). In this paper we offer results from a 9-site project to disseminate and implement a validated DA for patients considering leftventricular assist device (LVAD) therapy for advanced heart failure (18)(19)(20).…”

Section: Introductionmentioning

confidence: 99%

A Principal Components Analysis of Factors Associated with Successful Implementation of an LVAD Decision Support Tool

Kostick

Trejo

Bhimaraj

et al. 2020

Preprint

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Background: A central goal among researchers and policy makers seeking to implement clinical interventions is to identify key facilitators and barriers that contribute to implementation success. Despite calls from a number of scholars, empirical insights into the complex structural and cultural predictors of why DAs become routinely embedded in health care settings remains limited and highly variable across implementation contexts.Methods: We examined associations between “reach”, a widely used indicator (from the RE-AIM model) of implementation success, and multi-level site characteristics of nine LVAD clinics engaged over 18 months in implementation and dissemination of a decision aid for left-ventricular assist device (LVAD) treatment. Based on data collected from nurse coordinators, we explored factors at the level of the organization (e.g. patient volume), patient population (e.g. health literacy; average sickness level), clinician characteristics (e.g. attitudes towards decision aid; readiness for change) and process (how the aid was administered). We generated descriptive statistics for each site and calculated zero-order correlations (Pearson’s r) between all multi-level site variables including cumulative reach at 12 months and 18 months for all sites. We used principal components analysis (PCA) to examine any latent factors governing relationships between and among all site characteristics, including reach.Results: We observed strongest inclines in reach of our decision aid across the first year, with uptake fluctuating over the second year. Average reach across sites was 63% (s.d.=19.56) at 12 months and 66% (s.d.=19.39) at 18 months. Our (PCA) revealed that site characteristics positively associated with reach on two distinct dimensions, including a first dimension reflecting greater organizational infrastructure and standardization (characteristic of larger, more established clinics) and a second dimension reflecting positive attitudinal orientations, specifically, openness and capacity to give and receive decision support among coordinators and patients.Conclusions: Successful implementation plans should incorporate specific efforts to promote supportive and mutually informative interactions between clinical staff members and to institute systematic and standardized protocols to enhance the availability, convenience and salience of intervention tool in routine practice. Further research is needed to understand whether “core predictors” of success vary across different intervention types.

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Development and validation of a patient-centered knowledge scale for left ventricular assist device placement

Cited by 18 publications

References 26 publications

Caregivers of Patients With Left Ventricular Assist Devices

Caregivers of Patients With Left Ventricular Assist Devices

Identifying Knowledge Gaps among LVAD Candidates

A Principal Components Analysis of Factors Associated with Successful Implementation of an LVAD Decision Support Tool

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